Guangyu Jia, Kai Li

Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People’s Republic of China

Correspondence: Kai Li, Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai Road, Quanshan District, Xuzhou City, Jiangsu Province, People’s Republic of China, Tel/Fax +86051683356617, Email 1562830806@qq.com

Background: Prognostic Nutritional Index (PNI) is a useful predictor of outcomes in surgical patients. Emergency surgery for perforated peptic ulcer (PPU) remains associated with high morbidity and mortality. However, the relationship between PNI and outcomes after PPU surgery has not been fully explored. This study aimed to assess the performance of PNI in predicting morbidity and mortality among patients undergoing surgery for PPU.
Methods: This retrospective study included patients who underwent emergency surgery for PPU between 2018 and 2023. Multivariate analyses were performed to identify risk factors associated with postoperative morbidity and mortality. The predictive performance of PNI was evaluated using the area under the receiver operating characteristic curve.
Results: A total of 320 patients were included. The overall morbidity and mortality rates were 26.6% and 17.8%, respectively. The PNI was significantly lower in patients who experienced morbidity or mortality. Multivariate analysis showed that a low PNI was an independent predictor of both morbidity (Odds Ratio [OR], 1.05 per-point decrease; 95% Confidence Interval [CI], 1.01– 1.10; P = 0.02) and mortality (OR, 1.09 per-point decrease; 95% CI, 1.02– 1.16; P = 0.01). Patients were categorized into three PNI groups: normal (PNI ≥ 50, n = 78), mildly low (PNI 45– 50, n = 61), and severely low (PNI < 45, n = 181). Mortality and morbidity rates significantly differed across these groups: 1.3%, 7.4%, and 28.7% for mortality, and 10.3%, 16.4%, and 37% for morbidity, respectively (P < 0.001). The area under the curves (AUC) for PNI predicting morbidity and mortality were 0.73 (95% CI, 0.67– 0.79) and 0.81 (95% CI, 0.76– 0.86), respectively.
Conclusion: PNI is a reliable predictor of morbidity and mortality following surgery for PPU. A PNI-guided risk assessment could be useful for the perioperative management of PPU patients.

Keywords: perforated peptic ulcer, surgery, prognostic nutritional index, mortality, morbidity