Preoperative Nutritional Index as a Predictor of Pulmonary Infection and Mortality in Liver Transplant Patients

BACKGROUND Malnutrition has been linked to unfavorable outcomes in patients undergoing living donor liver transplantation. However, the utility of the preoperative prognostic nutritional index (PNI) as a predictor for postoperative pulmonary infections and in-hospital deaths remains uncertain. The current study aimed to assess the predictive utility of preoperative PNI in patients who undergo liver transplantation. MATERIAL AND METHODS A total of 177 patients who received deceased donor liver transplants from January 2020 to June 2021 were retrospectively enrolled. The potential predictive factors for postoperative pulmonary infection and in-hospital mortality were identified using univariate and multivariate analyses, and a predictive model was created, with the predictive performance assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of 177 included patients, the prevalence of postoperative pulmonary infection and in-hospital mortality was 46 (25.99%) and 25 (14.12%), respectively. Multivariate analysis indicated that preoperative normal PNI was associated with a reduced risk of postoperative pulmonary infection compared with low PNI (OR: 0.21; 95% CI: 0.09-0.49; P=0.001), and the predictive value of preoperative PNI on subsequent postoperative pulmonary infection was moderate, with an AUC of 0.66 (95% CI: 0.59-0.73). Furthermore, we noted preoperative normal PNI was associated with a reduced risk of in-hospital mortality (OR: 0.23; 95% CI: 0.08-0.70; P<0.001), and the predictive value of preoperative PNI on in-hospital mortality was mild, with an AUC of 0.65 (95% CI: 0.56-0.73). CONCLUSIONS Preoperative PNI was significantly associated with postoperative pulmonary infection and in-hospital mortality, and the predictive value of the PNI was moderate.