Application Of Prognostic Nutrition Index (OPNI) And Neutrophil / Lymphocyte Ratio (NLR) In Risk Assessment Of Postoperative Complications In Crohn 's Patients

Objective To investigate the application of Onodera prognostic nutrition index and neutrophil to lymphocyte ratio in risk evaluation of postoperative complications in patients with Crohn’s disease.Methods Clinical data of 108 patients with Crohn’s disease who had undergone bowel resection at Beijing Peking Union Medical College Hospital between March 2004 and September 2013 was analyzed retrospectively.OPNI was calculated as albumin value (g/L)+5×total number of lymphocytes(×109/L)in preoperative peripheral blood within one week and NLR was calculated as total number of neutrophils(×109/L)/total number of lymphocytes(x109/L).The distributions of OPNI and NLR in clinical features were analysed.The Receiver Operating Characteristic (ROC) curve and Youden index were used to determine the cutoff values for OPNI and NLR, which had the best sensitivity and specificity.According to the cutoff values, we divided the patients into high group and low group.We analyzed the correlation between OPNI and NLR.Logistic regression model was used to investigate the application of OPNI and NLR in risk evaluation of postoperative complications in patients with Crohn’s disease.Result The mean OPNI was 38.8±8.2.OPNI were significantly lower in patients with disease behaviour B3, low preoperative total number of lymphocytes, low preoperative hemoglobin, low preoperative prealbumin, low preoperative albumin, and those who’s daily energy of preoperative enteral nutrition within two weeks was less than 500 kcal (P< 0.05); The mean NLR was 5.9±12.1.NLR were significantly higher in patients with disease behaviour B3, low preoperative total number of neutrophils, low preoperative total number of lymphocytes, low preoperative prealbumin, and those who’s daily energy of preoperative enteral nutrition within two weeks was less than 500 kcal (P<0.05).When OPNI was 39.8, the Youden index was maximal, with a sensitivity of 70% and specificity of 68%.Using OPNI= 39.8 as the cut-off value, patients were divided into high OPNI (OPNI>39.8) and low OPNI (OPNI<39.8) groups.Preoperative total number of lymphocytes, preoperative hemoglobin, preoperative prealbumin and preoperative albumin had statistically significant differences in comparison between high OPNI group and low OPNI group.Such significant differences were also observed in disease behaviour B3 and daily energy of preoperative enteral nutrition within two weeks.When NLR was 4.1, the Youden index was maximal.Using NLR=4.1 as the cut-off value, patients were divided into high NLR (NLR≥4.1) and low (NLR< 4.1) groups.The disease behaviour B3, preoperative total number of neutrophils and preoperative total number of lymphocytes had statistically differences in comparison between high NLR group and low NLR group. OPNI and NLR had significant negative correlation.Logistic regression analysis model showed that preoperative smoking history within one year, low OPNI and high NLR were independent risk factors for postoperative complications in patients with Crohn’s disease. Conclusions Onodera Prognostic Nutrition Index and Neutrophil to Lymphocyte Ratio were important reference values in risk evaluation of perioperative complications in patients with Crohn’s disease. Patients with Crohn’s disease whose OPNI was less than 39.8, NLR was higher than 4.1, and those who had a history of smoking within one year were at higher risk of postoperative complications.