Cross-Lag Analysis of Prognostic Nutritional Index and Psychosomatic Symptom Clusters in Patients with Lung Cancer: A Longitudinal Study

Tingting Li,1,* Ying Wu,1,* Qun Yang,1,* Yuanyuan Zheng,1 Yunyun Xu,1 Huan Lin2 1Department of Cardiothoracic Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tingting Li, Department of Cardiothoracic surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, People’s Republic of China, Email [email protected]: To investigate the development trend of prognostic nutritional index and psychosomatic symptom clusters (multidimensional fatigue, generalized anxiety, difficulty in emotional regulation) in patients with lung cancer, and to analyze their correlation and predictive relationship.Methods: One hundred and eighty-five patients with lung cancer were selected as the research objects using the convenience sampling method. The prognostic nutritional index and psychosomatic symptom cluster were followed up at T1, T2, and T3 after the operation. Repeated measures ANOVA and cross - lag model were used for statistical testing.Results: A total of 185 questionnaires were distributed, and 7 invalid questionnaires were excluded, with an effective recovery rate of 96.22%. The results of repeated measurement showed the scores of prognostic nutritional index (F = 3.342, P = 0.031), multidimensional fatigue (F = 5.362, P < 0.001), generalized anxiety (F = 6.003, P < 0.001), and emotional regulation difficulties (F = 0.885, P = 0.420) at the three time points. Results of the cross - lag model: The level of prognostic nutritional index negatively predicted multidimensional fatigue symptoms (T1→T2: β = - 0.415, P = 0.003; T2→T3: β = - 0.433, P = 0.005) and generalized anxiety symptoms (T1→T2: β = - 0.364, P = 0.007; T2→T3: β = - 0.350, P = 0.012). The prognostic nutritional index at T2 significantly and negatively predicted emotional adjustment difficulties at T3 (T1→T2: β = 0.158, P = 0.151; T2→T3: β = - 0.233, P = 0.024). While in the psychosomatic symptom cluster, only multidimensional fatigue negatively predicted the prognostic nutritional index at the next node (T1→T2: β = - 0.314, P = 0.003; T2→T3: β = - 0.342, P = 0.001).Conclusion: The prognostic nutritional index of patients with lung cancer after surgery is closely related to the psychosomatic symptom cluster. The prognostic nutritional index has a negative predictive effect on the psychosomatic symptom cluster, and the multidimensional fatigue symptom also has a negative predictive effect on the prognostic nutritional index.Keywords: lung cancer, prognostic nutritional index, psychosomatic symptom clusters, multidimensional fatigue, generalized anxiety, difficulty in emotional regulation, relevance, cross - lag model, nursing