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. 2025 Feb 21;25(1):99.
doi: 10.1186/s12876-024-03583-3.

Immune-nutritional indicators predict short-term mortality in older patients after emergency gastrointestinal surgery: a retrospective study

Zechuan Jin  1 , Tinghan Yang  1 , Ziqiang Wang  2
Affiliations

Immune-nutritional indicators predict short-term mortality in older patients after emergency gastrointestinal surgery: a retrospective study

Zechuan Jin et al. BMC Gastroenterol. .

Abstract

Background: The aim of this study was to discover immune-nutritional indicators that can preoperatively predict short-term mortality in older patients undergoing emergency gastrointestinal surgery.

Methods: We retrospectively analyzed older patients older than 65 years of age who underwent various types of emergency gastrointestinal surgery under general anesthesia between January 2012 and December 2023. The immune-nutritional indicators were defined according to previous literature. The primary endpoint of this study was 90-day survival after surgery.

Results: A total of 4120 patients older than 65 years were included in this study. ROC curves and the decision curve analysis for eight factors predicting 90-day postoperative survival were well predicted by the mGPS (0.68, 95% CI: 0.66-0.70), PNI (0.68, 95% CI: 0.66-0.71) and CONUT score (0.68, 95% CI: 0.66-0.70). The models constructed by LASSO Cox and CoxBoost were used to score the risk for each patient, and the high LASSO Cox model risk score group had worse 90-day survival than the low score group, whereas patients in the low CoxBoost model score group had a worse prognosis. The AUC of the CoxBoost model was greater than that of the LASSO Cox model. A nomogram model was constructed using the variables screened by the LASSO Cox model with a C-index of 0.706.

Conclusions: Immune-nutritional factors could be a favorable predictor for older patients undergoing emergency gastrointestinal surgery.

Keywords: Emergency gastrointestinal surgery; Immune-nutritional indicators; Older patients; Short-term mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Because this study was a clinical retrospective analysis, the Ethics Committee of West China Hospital of Sichuan University was exempted from ethical approval and patient informed consent in accordance with national laws and institutional requirements. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) ROC curve analysis for a single indicator to predict 90-day postoperative survival. (B) Decision curve analysis for a single indicator to predict 90-day postoperative survival
Fig. 2
Fig. 2
(A) Risk factors selected using LASSO Cox regression analysis. The two vertical lines were drawn at the optimal scores by minimum criteria (lsft) and 1-s.e. criteria (right). (B) Risk factors selected using CoxBoost analysis
Fig. 3
Fig. 3
(A) Kaplan‒Meier survival curves of the LASSO Cox model. (B) Kaplan‒Meier survival curves of the CoxBoost model. (C) ROC curve analysis of the ability of the LASSO Cox model and CoxBoost model to predict 90-day postoperative survival
Fig. 4
Fig. 4
(A) Nomograms including the mGPS, CONUT, and PNI for 30-, 60-, and 90-day postoperative survival. (B) Calibration curve of the nomogram
See this image and copyright information in PMC

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