Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

Table 1 Overall complications following pancreaticoduodenectomy

Complications, n (%)			Total (n = 238)
No			81 (34.03)
yes			157 (65.97)
	Postoperative pancreatic fistula		118 (49.58)
		Grade BL	62 (26.05)
		Grade B	38 (15.97)
		Grade C	18 (7.56)
	Surgical site infection		32 (13.45)
	Intra-abdominal abscess		31 (13.02)
	Delayed gastric emptying		23 (9.66)
	Bile leak		15 (6.30)
	Chyle leak		10 (4.20)
	Intraperitoneal hemorrhage		9 (3.78)
	Acute kidney injury		8 (3.36)
	Cholangitis		7 (2.94)
	Lung atelectasis		5 (2.10)
	Septicemia		5 (2.10)
	Gastrointestinal hemorrhage		4 (1.68)
	Pleural effusion		4 (1.68)
	Pneumonia		4 (1.68)
	Intestinal obstruction		3 (1.26)
	Pulmonary embolism		3 (1.26)
	Acute pancreatitis		2 (0.84)
	Delirium		2 (0.84)
	Respiratory failure		2 (0.84)
	Cerebrovascular accident		1 (0.42)
	Hepatic failure		1 (0.42)
	Urinary tract infection		1 (0.42)
	Death		9 (3.78)

BL: Biochemical leakage.

Table 2 Clinicopathological characteristics in grade 0-II and III-V complication groups

Data		Total (n = 238)	Grade 0-II (n = 175)	Grade III-V (n = 63)	P
Age (yr), mean (SD)		60.01 (11.01)	59.89 (11.40)	60.33 (9.91)	0.788
Gender, n (%)
	Male	125 (52.52)	95 (54.29)	30 (47.62)	0.364
	Female	113 (47.48)	80 (45.71)	33 (52.38)
BMI (kg/m2), median (range)		22.10 (15.11-38.95)	21.85 (15.11-38.95)	22.65 (16.22-35.34)	< 0.05
Diabetes mellitus, n (%)
	No	173 (72.69)	123 (70.29)	50 (79.37)	0.165
	Yes	65 (27.31)	52 (29.71)	13 (20.63)
ASA class, n (%), n = 234
	I	6 (2.56)	3 (1.75)	3 (4.76)	< 0.05
	II	80 (34.19)	64 (37.43)	16 (25.40)
	III	135 (57.69)	97 (56.73)	38 (60.32)
	IV	10 (4.27)	6 (3.51)	4 (6.35)
	V	3 (1.28)	1 (0.58)	2 (3.17)
Smoking, n (%)
	No	163 (68.49)	115 (65.71)	48 (76.19)	0.125
	Yes	75 (31.51)	60 (34.29)	15 (23.81)
Previous biliary intervention, n (%)
	No	84 (35.29)	60 (34.29)	24 (38.10)	0.587
	Yes	154 (64.71)	115 (65.71)	39 (61.90)
Total bilirubin (mg/dL), median (range)		1.20 (0.10-35.0)	1.20 (0.10-35.0)	1.30 (0.20-25.0)	0.956
Albumin (g/L), median (range)		34.9 (18.7-49.0)	35 (18.7-49.0)	34.1 (23.1-45.0)	< 0.05
	≥ 35	116 (48.47)	91 (52.0)	25 (39.68)	0.093
	< 35	122 (51.26)	84 (48.0)	38 (60.32)
Preoperative diagnosis, n (%)
	Benign	55 (23.11)	43 (24.57)	12 (19.05)	0.372
	Malignant	183 (76.89)	132 (75.43)	51 (80.95)
Pancreatic, n (%)
	Pancreatic	131 (55.04)	95 (54.29)	36 (57.14)	0.696
	Nonpancreatic	107 (44.96)	80 (45.71)	27 (42.86)
	Operating time, median (range)	465 (240-900)	420 (240-900)	480 (270-840)	0.175
	Blood loss (mL), median (range), n = 237	800 (100-13 000)	800 (100-8000)	1000 (150-13 000)	0.051
Pancreatic texture, n (%) n=227
	Hard firm	113 (49.78)	88 (52.69)	25 (41.67)	0.143
	Soft	114 (50.22)	79 (47.31)	35 (58.33)
Pancreatic diameter (mm) median (range), n = 225		3 (1-20)	3 (1-20)	4 (1-20)	0.718
PNI, median (range)
	Preoperative, n = 230	98.9 (0.4-382.2)	98.9 (0.4-382.2)	101.5 (39.2-204.9)	0.456
	POD 1, n = 140	49.3 (0.2-111.6)	56.3 (0.2-425.6)	45.3 (0.2-111.6)	0.060
	POD 2, n = 81	43.1 (0.2-331.1)	45.5 (0.2-331.1)	35.2 (0.2-78.2)	< 0.05
	POD 3, n = 133	40.5 (0.1-290.2)	45.5 (0.2-290.2)	30.0 (0.1-85.9)	< 0.01
	POD 4, n = 53	31.7 (0.2-205.8)	36.8 (0.2-205.8)	27.1 (0.2-61.4)	0.112
	POD 5, n = 70	41.0 (0.1-147.4)	38.7 (0.1-147.4)	41.8 (0.2-123.2)	0.396

BMI: Body mass index; PNI: Prognostic nutritional index; POD: Postoperative day; SD: Standard deviation.

Table 3 Univariate and multivariate analysis of the factors associated with grade III-V complications

Data			Univariate		Multivariate
			OR (95%CI)	P	OR (95%CI)	P
Age (yr)			1.003 (0.97-1.03)	0.787
Gender
	Male		1
	Female		1.306 (0.73-2.32)	0.364
BMI (kg/m2)			1.055 (0.98-1.13)	0.135
Diabetes mellitus
	No		1
	Yes		0.615 (0.31-1.22)	0.168
ASA class
	I		1
	II		0.250 (0.04-1.35)	0.108
	III		0.391 (0.07-2.02)	0.264
	IV		0.667 (0.08-5.12)	0.697
	V		2.00 (0.11-35.80)	0.638
Smoking
	No		1
	Yes		0.598 (0.31-1.15)	0.127
Previous biliary intervention
	No		1
	Yes		0.847 (0.46-1.53)	0.588
Total bilirubin (mg/d/L)			0.994 (0.93-1.05)	0.850
Albumin (g/L)			0.943 (0.89-0.99)	< 0.05	0.883 (0.80-0.96)	< 0.01
Preoperative diagnosis
	Benign		1
	Malignant		1.384 (0.67-2.83)	0.374
Pancreatic
	Pancreatic		1
	Nonpancreatic		0.890 (0.49-1.59)	0.696
Operating time			1.002 (0.99-1.01)	0.154
Blood loss (mL)			1.254 (1.02-1.54)	0.030
Pancreatic texture
		Hard/firm	1
		Soft	1.559 (0.85-2.83)	0.144
Pancreatic diameter (mm)			0.994 (0.88-1.12)	0.921
PNI (POD 3)			0.981 (0.96-0.99)	< 0.05
		≥ 40.5	1		1
		< 40.5	2.619 (1.17-5.83)	< 0.05	2.776 (1.21-6.38)	< 0.05

BMI: Body mass index; CI: Confidence interval; OR: Odds ratio; PNI: Prognostic nutritional index; POD: Postoperative day.