Prognostic Role of Preoperative Nutritional and Immunological Assessment in the Surgical Patient

Abstract

The utilization of delayed hypersensitivity response (DHR) for the identification of high-risk patients with regard to postoperative septic complications is still discussed. The aim of this study was to clarify how much DHR may improve the prognostic capacity of nutritional assessment (NA). Nutritional and immunological evaluations were performed at admission on 405 patients undergoing elective general surgical procedures. Subjects with serum albumin less than or equal to 3.0 g/dl or total iron-binding capacity less than or equal to 220 micrograms/dl or weight loss greater than or equal to 10% with respect to usual body weight were classified as malnourished. DHR was assessed by performing skin tests with four recall antigens: PPD, candida, trichophyton, sk-sd. The incidence of postoperative complications resulted higher among the 187 malnourished patients (31.0%) than in the 218 well-nourished ones (14.2%) (p less than 0.001), and among the 213 anergic patients (29.6%) than in the 192 normal responders (13.5%) (p less than 0.001). To determine how much skin tests may improve the prognostic ability of NA, the relationship between DHR and postoperative complications was also studied in the malnourished and in the well-nourished patients, separately. In the malnourished group, the patients with an impairment of DHR had a higher incidence of postoperative infections than normal responders (p less than 0.05). In the well-nourished group, no significant differences were found between anergic patients and normal responders. In our study, DHR slightly improved the prognostic capacity of NA. Therefore, the first approach to identify the high-risk patients seems to be the unexpensive, quick and available determination of nutritional status.

Serum hepatocyte growth factor as an index of disease status of patients with colorectal carcinoma

“…In clinical studies, a relationship between the concentration of HGF in serum or cancer tissue and the progression of disease has been noted in patients with gastric cancer (Taniguchi et al, 1997), oesophageal cancer (Takada et al, 1995) and breast cancer (Yamashita et al, 1994;Taniguchi et al, 1995). However, there are no reports regarding the clinical relevance of HGF in patients with colorectal carcinoma.Malnutrition or immunosuppression are involved in the development of life-threatening complications in patients with malignancies (Braga et al, 1988;Nishi et al, 1988;Dannhauser et al, 1995;Triantafillidis et al, 1995;Windsor et al, 1995;Goransson et al, 1996). Patients with advanced cancer and cachexia typically demonstrate modestly increased rates of energy expenditure with concomitant diminished food intake.…”

“…Malnutrition or immunosuppression are involved in the development of life-threatening complications in patients with malignancies (Braga et al, 1988;Nishi et al, 1988;Dannhauser et al, 1995;Triantafillidis et al, 1995;Windsor et al, 1995;Goransson et al, 1996). Patients with advanced cancer and cachexia typically demonstrate modestly increased rates of energy expenditure with concomitant diminished food intake.…”

Evaluation of the Predictive Performance of Nutritional Indicators by Receiver‐Operating Characteristic Curve Analysis

“…Another possible bias could be the different cutoff values of nutritional parameters chosen to identify patients at high risk to develop surgery-related infections. 4,6,10,11,[32][33][34][35] In this study, we included only cancer patients who underwent major surgery and who received perioperative short-term antibiotic prophylaxis. We considered those nutritional parameters that are part of the preoperative routine assessment.…”

A Single Unit of Transfused Allogeneic Blood Increases Postoperative Infections

“…Patients were considered as having postoperative infections if they developed in intra-abdominal abscess, surgical wound infection, pneumonia, peritonitis, temperature above 38 C for more than 3 days without any evident septic focus according to previous definitions [5,[13][14][15]. The diagnosis of infection was performed in a prospective manner for all patients by physicians who were not aware of the transfusion status of the patients.…”