Prognostic nutritional index (PNI) for predicting perioperative complications after tuberculous constrictive pericarditis surgery: a single-center retrospective study.

Abstract

Background: Perioperative complications following pericardiectomy in patients with constrictive pericarditis can significantly affect cardiac function recovery and postoperative outcomes. The prognostic nutritional index (PNI), a well-established nutritional marker, has been shown to predict outcomes in various diseases. However, its role as a predictive factor in patients with tuberculous constrictive pericarditis undergoing pericardiectomy remains unclear. This study aimed to evaluate the association between preoperative PNI and adverse perioperative outcomes in this patient population.

Methods: This retrospective cohort study included 158 patients with tuberculous constrictive pericarditis who underwent pericardiectomy between January 2016 and June 2024. Preoperative PNI was calculated using the formula: (10 × serum albumin [g/dL]) + (0.005 × total lymphocyte count [cells/mm³]). The optimal PNI cutoff value was determined via ROC curve analysis, and patients were categorized into two groups: PNI ≥ 36.11 and PNI < 36.11. Univariate and multivariate logistic regression analyses were performed to assess the association between PNI and adverse perioperative outcomes.

Results: Of the 158 patients, 67.7% had a PNI < 36.11. Significant differences were observed between the two groups in hemoglobin levels, platelet count, C-reactive protein, indirect bilirubin, lactate dehydrogenase, cholinesterase, B-type natriuretic peptide (BNP), D-dimer, positive ventricular septal bounce sign, pericardial calcification, pericardial effusion, and pleural effusion. Patients with PNI < 36.11 experienced longer total and postoperative hospital stays. The incidence of adverse perioperative events was 76.6% (82/107) in the PNI < 36.11 group. Both univariate logistic regression (OR = 4.324, 95% CI: 2.12-8.816) and multivariate logistic regression (OR = 3.586, 95% CI: 1.523-8.444) confirmed that lower PNI was significantly associated with increased adverse perioperative outcomes.

Conclusion: A lower preoperative PNI is strongly associated with a higher incidence of adverse perioperative outcomes in patients undergoing pericardiectomy for tuberculous constrictive pericarditis. As a reliable indicator of preoperative nutritional status, PNI can serve as an independent risk factor and a modifiable clinical parameter to reduce adverse outcomes.