Preoperative serum prealbumin levels in predicting postoperative complications and survival in malignant bowel obstruction surgery

Abstract

Purpose This study aims to assess the predictive value of preoperative prealbumin (PA) concentration in cases of Malignant bowel obstruction (MBO) for postoperative complications and long-term survival. Methods Single-factor and multi-factor logistic regression analyses were performed to identify independent risk factors for severe complications and infectious complications. Simultaneously, single-factor and multi-factor Cox regression analyses were employed to identify independent risk factors for overall survival (OS), and corresponding nomograms were created. Kaplan-Meier survival curves were generated for grouped data with statistically significant differences. The area under the curve (AUC) was compared to assess the testing efficiency of different nutritional indicators for postoperative severe complications. Results There was a statistically significant difference in the comparison of overall complications and infectious complications between the two groups in different CD grades (p＜0.001). Specifically, the incidence of CD≥3 in the super-low PA group was higher (p＜0.001), and a gradual increase in the severity of overall and infectious complications postoperatively was observed with decreasing PA levels (p＜0.001). PA (p<0.001) and intestinal stent placement (p=0.015) were identified as independent influencing factors for early postoperative severe complications (CD≥3), while PA was an independent influencing factor for postoperative infectious complications (p<0.001). PA, gender, surgical approach, TNM staging, and postoperative chemotherapy were identified as independent predictors of overall survival (OS). Compared to indicators like FPR and AFP, PA demonstrated the highest testing efficiency (AUC=0.888). Conclusion Preoperative PA has significant predictive value for early postoperative complications and overall survival in MBO,providing new insights into perioperative nutritional intervention and surgical approach selection for MBO patients.