Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study

Abstract

Postpancreatectomy hemorrhage (PPH) is the most lethal complication of pancreatoduodenectomy (PD). The main risk factor for PPH is the development of a postoperative pancreatic fistula (POPF). Recent evidence shows that the geriatric nutritional risk index (GNRI) may be predictive indicator for POPF. In this study, we aimed to evaluate whether GNRI is a reliable predictive marker for PPH following PD. The present study retrospectively evaluated 121 patients treated with PD at Ageo Central General Hospital in Japan between January 2015 and March 2020. We investigated the potential of age, gender, body mass index, serum albumin, American Society of Anesthesiologists classification (ASA), diabetes mellitus and smoking status, time taken for the operation, estimated blood loss, and postoperative complications (POPF, bile leak, and surgical site infections) to predict the risk of PPH following PD using univariate and multivariate analyses. Ten patients had developed PPH with an incidence of 8.3%. Among them, the patients were divided into bleeding group (n = 10) and non-bleeding group (n = 111). The bleeding group had significantly lower GNRI values than those in the non-bleeding group (p = 0.001). We determined that the cut-off value of GNRI was 92 accounting for a sensitivity 80.0%, specificity 82.9%, and likelihood ratio of 4.6 using receiver operating characteristic curve analysis. A GNRI of <92 was statistically associated with PPH in both univariate (p < 0.001) and multivariate analysis (p = 0.01). Therefore, we could identify that a GNRI < 92 was an independently potential predictor of PPH risk following PD. We should alert surgeons if patients have low level GNRI before PD.

Association between the Preoperative C-Reactive Protein-to-Albumin Ratio and the Risk for Postoperative Pancreatic Fistula following Distal Pancreatectomy for Pancreatic Cancer

“…However, no robust evidence has been established to support surgical techniques. In contrast, a number of POPF risk factors have been suggested, such as a soft pancreas, obesity, diabetes mellitus, a lower geriatric nutritional risk index (GNRI), lower albumin levels, blood loss, and an extended operation time [29][30][31]. Notably, a meta-analysis revealed that a soft pancreas, a higher BMI, blood transfusion, blood loss, and the operative time were major predictors of POPF [7].…”

Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Postoperative Pancreatic Fistula following Pancreatoduodenectomy: A Single-Center, Retrospective Study

“…However, a definitive risk factor for POPF has not yet been established. For such occasions, several POPF predictive scores, including inflammatory and/or nutritional status, have been developed, such as the GNRI [ 4 , 5 ], controlling nutritional status score [ 20 ], and prognostic nutritional index [ 22 ] to detect POPF at an earlier phase and with more precision. In addition, those scores using inflammatory or nutritional status, such as GNRI [ 23 ], the platelet-to-lymphocyte ratio [ 24 ], and neutrophil-to-lymphocyte ratio (NLR) [ 25 , 26 ], have been designed as prognostic factors in several types of cancers.…”

“…Moreover, recent evidence has shown that POPF unfavorably affects the prognosis in patients with pancreatic cancer [ 3 ]. We previously showed that the geriatric nutritional risk index (GNRI) could predict POCs among patients who underwent pancreatic resection for periampullary diseases [ 4 , 5 , 6 , 7 ]. Instead of GNRI as a nutritional parameter, we explored another novel indicator for the risk of POPF following PD.…”

Geriatric Nutritional Risk Index is related to the risk of stroke‐associated pneumonia

“…This index can predict the complications induced by malnutrition as well (Cereda et al., 2009 ). Predictions of some diseases incidence and prognosis have been made through GNRI in earlier investigations, including postoperative survival rate of esophageal cancer (Kubo et al., 2019 ), postoperative complications of gastric cancer (Kushiyama et al., 2018 ), postoperative bleeding of the pancreas (Funamizu et al., 2020 ), mortality of heart failure (Li et al., 2021 ), the prognosis of coronavirus disease(COVID‐19) (Lidoriki et al., 2020 ; Recinella et al., 2020 ), and poststroke cognitive impairment (Lee et al., 2021 ). Besides, studies have also found that malnutrition can lead to complications such as decreased immunity and infection (Keusch, 2003 ).…”