Prognostic Nutritional Index as a Predictive Biomarker of Post-Operative Infectious Morbidity in Gynecological Cancer Patients: A Prospective Cohort Study

Abstract

Malnutrition significantly impacts the post-operative process of gynecological cancer patients. A prominent variable for determining perioperative morbidity is the Prognostic Nutritional Index (PNI). To investigate PNI’s predictive value on the risk of post-operative infections, we conducted a prospective cohort study involving women who underwent surgery for gynecological malignancies. Out of the 208 patients enrolled, 28 (13.5%) were malnourished and post-operative infections occurred in 43 patients. Notably, there was a significant difference in PNI between patients who developed infections and those who did not (p = 0.027), as well as between malnourished patients and those with normal nutritional status (p = 0.043). Univariate analysis showed that preoperative PNI predicts the risk of post-operative infections better than post-operative white blood cell count (AUC of 0.562 vs 0.375). However, the most accurate diagnostic results in the multivariate analysis were obtained from random forest and classification tree models (AUC of 0.987 and 0.977, respectively). Essentially, PNI and post-operative white blood cell count provided the best information gain according to rank probabilities. In conclusion, PNI appears to be a critical parameter that merits further investigation during the preoperative evaluation of gynecological malignancies.

Author Contributions

V.P. and D.H. contributed to the study conception and design. Data collection and analysis were performed by V.P and D.E.V. The final draft of the manuscript was written by all authors V.P., T.P., D.H., V.L., D.E.V., A.R., N.T. and all authors commented on previous versions of the manuscript. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The institutional review board of Alexandra University Hospital approved this study prior to its onset (IRB approval number: 238/2020).

Informed Consent Statement

Patient consent was obtained prior to the inclusion of patients in the study.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Data available upon reasonable request

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.