Association between preoperative nutritional status, inflammation, and intestinal permeability in elderly patients undergoing gastrectomy: a prospective cohort study

Risk factors for surgical site infection after patellar fracture surgery in the elderly

BACKGROUND

Patellar fractures are a common knee injury among elderly patients, with a high risk of developing surgical site infections (SSI) postoperatively, which severely affects patient prognosis and quality of life. Elderly patients are more susceptible to SSI due to various factors such as decreased immune function and chronic diseases. Therefore, identifying the risk factors for SSI is of great clinical significance for prevention.

OBJECTIVE

This study aims to analyze the risk factors for postoperative SSI in elderly patients with patellar fractures, providing a basis for developing more effective clinical prevention and treatment strategies.

METHODS

This retrospective study collected data from 856 elderly patients who underwent patellar fracture surgery at Baoding First Central Hospital between January 2017 and December 2023. Patients were divided into SSI and non-SSI groups based on the occurrence of SSI, and their demographic data, comorbidities, and laboratory results were analyzed. Logistic regression was used to identify independent risk factors for SSI, and ROC curve analysis was conducted to determine the optimal cutoff point for predictive indicators.

RESULTS

The incidence of SSI was found to be 2.1%. Univariate analysis showed that BMI, surgical delay, diabetes, hematocrit (HCT), and albumin (ALB) were significantly associated with SSI. Logistic regression analysis further confirmed that BMI (p = 0.043), surgical delay (p = 0.000), HCT (p = 0.038), ALB (p = 0.015), and diabetes (p = 0.022) were independent risk factors for SSI. ROC curve analysis indicated that the optimal cutoff points for BMI, HCT, and ALB were 25.39 kg/m2, 35.62%, and 39.3 g/L, respectively, with an AUC of 0.794 for the combined predictive indicators.

CONCLUSION

High BMI, surgical delay, diabetes, low HCT, and low ALB are independent risk factors for postoperative SSI in elderly patients with patellar fractures. Preoperative management targeting these high-risk factors, such as optimizing patient weight, controlling diabetes, and improving nutritional status, can effectively reduce the incidence of SSI and improve postoperative outcomes. Future multicenter studies may further validate these findings and provide additional prevention strategies.

Efficacy of probiotics combined with enteral nutrition therapy on intestinal flora, digestive tract symptoms and endogenous environment in patients with gastric cancer undergoing chemotherapy

Objective

To investigate the effects of probiotics combined with enteral nutrition therapy on intestinal flora, digestive tract symptoms and endogenous environment in patients with gastric cancer undergoing chemotherapy.

Methods

In this retrospective study, eighty patients with gastric cancer undergoing chemotherapy admitted to Affiliated Hospital of Hebei University from January 2021 to September 2023 were included and divided into two groups by random number table method: the enteral nutrition group and the probiotics combined enteral nutrition group (n=40 each group). The differences in the number of intestinal flora, nutritional indicators, immune function, endotoxin, D-lactic acid levels between the two groups, and the digestive tract symptoms of the two groups before and after treatment were compared and recorded.

Results

The levels of serum total protein (TP), prealbumin (PAB), albumin (ALB) and transferrin (TF) in both groups were higher than those before treatment, and those in the probiotics combined with enteral nutrition group were higher than those in the enteral nutrition group (p< 0.05). The levels of immunoglobulin A (lgA), immunoglobulin M (lgM) and immunoglobulin G (lgG) in the two groups were lower than before treatment, and those in the probiotics combined with the enteral nutrition group were lower than those in the enteral nutrition group (p< 0.05).

Conclusion

Probiotics combined with enteral nutrition results in various benefits in the treatment of patients with gastric cancer undergoing chemotherapy, improving immunity, and reducing gastrointestinal symptoms.

Nomogram to predict feeding intolerance in critically ill children

Feed intolerance (FI) is significantly associated with poor prognosis in critically ill patients. This study aimed to understand the characteristics of children with FI and identify the factors predicting FI in critically ill children. This retrospective cohort study was conducted between January 2017 and June 2022 in the Pediatric Intensive Care Unit of a specialized children's hospital. Eighteen factors, including age, body mass index for age z-score (BAZ) < -2, paediatric index of mortality (PIM)3 score, Glasgow coma scale score, mechanical ventilation (MV), enteral nutrition delay, vasoactive drugs, sedatives, sepsis, heart disease, neurological disease, hypokalemia, arterial PH < 7.35, arterial partial pressure of oxygen (PaO2), blood glucose, hemoglobin, total protein, and albumin, were retrieved to predict FI. The outcome was FI during PICU stay. During the study period, a total of 854 children were included, of which 215 children developed FI. Six predictors of FI were selected: PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2. Multivariate logistic regression analysis showed that higher PIM3 score, MV, sepsis, hypokalemia, and lower PaO2 were independent risk factors for FI, whereas higher albumin was an independent protective factor for FI. The C-index of the predictive nomogram of 0.943 was confirmed at internal validation to be 0.940, indicating a good predictive value of the model. Decision curve analysis shows good clinical applicability of the nomogram in predicting FI.    Conclusion: The nomogram was verified to have a good prediction performance based on discrimination, calibration, and clinical decision analysis. What is Known: • Research has demonstrated that gastrointestinal (GI) dysfunction is not only a fundamental element of Multiple Organ Dysfunction Syndrome (MODS), but also the initiator of MODS. • Previous study has demonstrated a significant association between FI and poor prognosis in critically ill patients. What is New: • We excluded patients with primary gastrointestinal tract disease from our study, and we observed an incidence of FI of 25.2% in the Pediatric Intensive Care Unit (PICU). • Our study revealed that PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2 are significant predictors of FI.

A novel nomogram based on the prognostic nutritional index for predicting postoperative outcomes in patients with stage I-III gastric cancer undergoing robotic radical gastrectomy

BACKGROUND

The inflammation and nutrition status are crucial factors influencing the outcome of patients with gastric cancer. This study aims to investigate the prognostic value of the preoperative prognostic nutritional index (PNI) in patients with stage I-III gastric cancer undergoing robotic radical gastrectomy combined with Enhanced Recovery after Surgery (ERAS), and further to create a clinical prognosis prediction model.

STUDY

525 patients with stage I-III gastric cancer who underwent ERAS combined with RRG from July 2010 to June 2018 were included in this work, and were divided randomly into training and validating groups in a 7-to-3 ratio. The association between PNI and overall survival (OS) was assessed by Kaplan-Meier analysis and the log-rank test. Independent risk factors impacting postoperative survival were analyzed with the Cox proportional hazards regression model. A nomogram for predicting OS was constructed based on multivariate analysis, and its predictive performance was evaluated using Harrell's concordance index (C-index), calibration plots, ROC curve, decision curve analysis (DCA), and time-dependent ROC curve analysis.

RESULTS

Survival analyses revealed the presence of a significant correlation between low preoperative PNI and shortened postoperative survival (P = 0.001). According to multivariate analysis, postoperative complications (P < 0.001), pTNM stage (II: P = 0.007; III: P < 0.001), PNI (P = 0.048) and lymph node ratio (LNR) (P = 0.003) were independent prognostic factors in patients undergoing ERAS combined with RRG. The nomogram constructed based on PNI, pTNM stage, complications, and LNR was superior to the pTNM stage model in terms of predictive performance. The C-indexes of the nomogram model were respectively 0.765 and 0.754 in the training and testing set, while AUC values for 1-year, 3-year, and 5-year OS were 0.68, 0.71, and 0.74 in the training set and 0.60, 0.67, and 0.72 in the validation set.

CONCLUSION

Preoperative PNI is an independent prognostic factor for patients with stage I-III gastric cancer undergoing ERAS combined with robotic radical gastrectomy. Based on PNI, we constructed a nomogram for predicting postoperative outcomes of gastric cancer patients, which might be utilized clinically.