Correlative Study Of Preoperative Inflammatory Composite Indicators NLR,PLR,SII,PNI And Postoperative Prognosis In Patients With Intestinal Fistula

Objective: To study the correlation of preoperative NLR,PLR,SII,PNI and other inflammatory composite indexes with postoperative complications of intestinal fistula,and to evaluate their predictive efficacy for the prognosis of patients after intestinal fistula.Methods: A retrospective analysis of 319 patients with intestinal fistula admitted to the Department of Gastrointestinal Surgery,Hunan Provincial People’s Hospital from January 2015 to December 2019,and finally included 157 patients with intestinal fistula patients with complete clinical data and meeting the inclusion criteria were included in the study as an experimental group.At the same time,among all the healthy examinees of the same period in the physical examination center of Hunan Provincial People’s Hospital,157 cases were randomly selected as a control group.At the same time,among all the contemporaneous health check-ups in the Physical Examination Center of Hunan Provincial People’s Hospital,157 cases were randomly selected as the control group.Results SPSS22.0software was used for statistical analysis.The two independent samples t test and the comparison between groups were used to analyze the Mann-Whitney z test.NLR and PLR were compared between the experimental group(intestinal fistula group)and the control group(healthy group),SII,PNI,procalcitonin(PCT),serum albumin,C-reactive protein(CRP)and other indicators.Then use the receiver characteristic curve(ROC curve)to determine the critical value of each inflammatory composite index,and use the chi-square test to analyze the postoperative complications,high-and low-value group patients in the NLR group,PLR group,SII group and PNI group.There was no difference in postoperative mortality and postoperative hospital stay,that is,the correlation analysis of the inflammatory composite indexes of NLR,PLR,SII,PNI and postoperative complications of intestinal fistula in patients with intestinal fistula.Then use the COX risk proportional regression model to analyze the relationship between the preoperative NLR,PLR,SII,and PNI inflammatory composite indexes of patients with intestinal fistula and postoperative survival of intestinal fistula.Finally,the area under the ROC curve(AUC)was used to evaluate the predictive efficacy of NLR,PLR,SII,and PNI in the prognosis of patients with intestinal fistula.Results: 1.Compared with the control group(healthy group),the experimental group(intestinal fistula group)NLR(P <0.001),PLR(P<0.001),SII(P <0.001),CRP(P <0.001),PCT(P = 0.015)value increased significantly,while PNI(P <0.001)value and serum albumin(P= 0.036)decreased significantly,the difference was statistically significant(P <0.05).2.All 157 patients with intestinal fistula in this study underwent laparotomy,and the average hospital stay was 17 days after operation,of which 35(22.29%)were hospitalized for more than 17 days,and 7patients with intestinal fistula recurred after operation(4.46%),In the course of postoperative treatment,8 cases(5.1%)developed intra-abdominal hemorrhage,27 cases(17.2%)showed positive postoperative blood culture,and 13 cases(8.28%)developed postoperative intestinal obstruction.28 cases(17.83%)suffered post-abdominal infection.A total of 31 patients(19.75%)suffered from poor abdominal incision healing after operation,and 5 patients(3.18%)died of intestinal fistula after operation.Correlation analysis showed that the preoperative NLR,PLR,SII,and PNI values of patients with intestinal fistula were significantly correlated with the hospital stay after definitive operation of intestinal fistula and postoperative complications,P <0.05.3.Single factor regression analysis showed that preoperative NLR(P= 0.008),PLR(P <0.001),SII(P <0.001),PNI(P = 0.004),CRP(P =0.049),PCT(P = 0.04))And other indicators are important factors thataffect the prognosis of patients with intestinal fistula(P <0.05).Multivariate regression analysis showed that PLR(HR = 2.364,P = 0.04)and PNI(HR = 0.095,P = 0.023)were independent risk factors that affected the prognosis of postoperative intestinal fistula.4.ROC curve analysis showed that the efficacy of various inflammatory composite indicators before intestinal fistula patients for predicting the prognosis of postoperative intestinal fistula were: NLR(AUC = 0.632),PLR(AUC = 0.698),SII(AUC = 0.714),PNI(AUC =0.594),CRP(AUC = 0.468),PCT(AUC = 0.445);we found that the area under the curve of SII(AUC = 0.714)is the largest,so we can consider the prognostic nutrition index(SII)to be a composite inflammatory index Medium predicts the efficacy of postoperative prognosis of intestinal fistula,and other inflammatory composite indicators have certain value in predicting the prognosis of postoperative intestinal fistula.Conclusion:1.Increased NLR,PLR,SII value or decreased PNI value before operation in patients with intestinal fistula indicates that the risk of postoperative complications is significantly increased;2.The pre-operative NLR,PLR,SII,PNI inflammatory composite indexes are the predictors of postoperative prognosis of patients with intestinal fistula,and the preoperative SII assessment efficiency is the best.