LACK OF IMPROVEMENT OF PROGNOSTIC PERFORMANCE OF WEIGHT-LOSS WHEN COMBINED WITH OTHER PARAMETERS

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.