L. Gianotti et al., LACK OF IMPROVEMENT OF PROGNOSTIC PERFORMANCE OF WEIGHT-LOSS WHEN COMBINED WITH OTHER PARAMETERS, Nutrition, 11(1), 1995, pp. 12-16
This prospective study was designed to evaluate the ability of single
and combined prognostic parameters in predicting postoperative infecti
ons in cancer surgical patients. The evaluation was based on multiple
logistic analysis and receiver operating characteristic (ROC) curve an
alysis. The Younden's index (YI) was used to select threshold values o
f the parameters. This analysis was applied in 398 patients undergoing
curative elective surgery for gastric, colorectal, or pancreatic canc
er. At admission, the percentage of body weight loss, serum albumin, t
otal lymphocyte count, total iron-binding capacity, and serum cholines
terase activity were evaluated. In all patients, the type and rate of
postoperative infection were recorded. Multiple logistic analysis show
ed weight loss as the most predictive variable (p = 0.02), when taken
individually. Its best cutoff value was 10% (YI = 1.27, p = 0.00001, R
OC area = 0.62). When serum albumin was added as the second-best varia
ble, with a threshold of 35 g/L, the combined YI was 1.27, and the ROC
area was 0.65 (p NS vs. weight loss). Total lymphocyte count dichotom
ized at 2200 million/L was the third variable added to weight loss and
serum albumin (YI = 1.31, ROC area = 0.59). In conclusion, weight los
s split at 10% appears as the only index with a moderate prognostic pe
rformance that is worth evaluating in the preoperative nutrition asses
sment. A nonsignificant improvement of predictive ability was obtained
by the combination of serum albumin, total lymphocyte count, total ir
on-binding capacity, or serum cholinesterase activity.