Prognostic nutritional index in hepatobiliary surgery

Malnutrition has long been recognized as a potential source of increased morbidity and mortality in patients with various disorders, including those undergoing hepatobiliary surgery. To elucidate the role of malnutrition in postoperative complications in hepatobiliary surgery, the nutritional status of 73 patients was evaluated with the Prognostic Nutritional Index (PNI) devised by Dr. Mullen. PNI was calculated based on the following parameters: albumin, transferrin, triceps skin folds and delayed cutaneous hypersensitivity (DH). DH was performed with four skin antigens: candida, trichophyton, streptokinase/streptodornase and PPD. Based on the results the patients were stratified into two groups, a low-risk group with PNI less than 40 and a high-risk group with PNI greater than or equal to 40. Complications occurred in 10 of 34 patients (29%) in the low-risk group and in 15 of 39 patients (38%) in the high-risk group. There were 2 deaths in the latter and none in the former group, the difference was not statistically significant. We conclude that PNI fails to predict postoperative complications in hepatobiliary surgery patients. Either the formula of PNI, which is derived from gastrointestinal surgery patients, is not applicable to patients undergoing hepatobiliary surgery, or factors other than nutrition are involved in the development of postoperative complications in hepatobiliary surgery.