| Objective:Hepatic alveolar echinococcosis(HAE)is a zoonotic disease that seriously endangers human health.It has the characteristics of high pathogenicity,high fatality rate and poor prognosis.Body mass index(BMI)is an important index to evaluate the nutritional status of human body,and has certain guiding significance to evaluate the prognosis of hepatic alveolar echinococcosis after hepatectomy.The chapter two of this study was to investigate the predictive value of BMI level for short-term complications after hepatectomy in HAE patients.The chapter three aims to explore the predictive value of BMI level on long-term prognosis after HAE hepatectomy and to study the risk factors for poor prognosis after HAE hepatectomy.Methods:The chapter two of this study,a total of 316 patients hospitalized for hepatic alveolar echinococcosis in affiliated hospital of qinghai university from September 2016 to September 2021 were retrospectively included,among which 11patients were lost to follow-up,with a loss to follow-up rate of 3.48%.A total of 305cases were included.BMI was calculated based on the height and weight of the patients at admission,and all the patients were divided into four groups:the first quartile(Q1),the second quartile(Q2),the third quartile(Q3),and the fourth quartile(Q4)by the method of BMI quartile.General data,laboratory indicators and clinical data of the patients were collected,and statistical methods such as mixed model regression analysis and ROC diagnostic test were used for data analysis.The chapter three,data of patients with hepatic alveolar echinococcosis who received hepatectomy in affiliated hospital of qinghai university from September 2016 to February 2020 were continuously retrospectively collected.A total of 239 patients met the criteria of admission and discharge,of which 29 were lost to follow-up,with a loss to follow-up rate of 12.1%.A total of 210 patients were included after follow-up.According to the follow-up results,the patients were divided into poor prognosis group(n=43 cases)and favourable prognosis group(n=167 cases).The laboratory indicators and clinical data of the patients were collected and analyzed by Cox regression model,ROC diagnostic test and other statistical methods.Results:The chapter two:According to the BMI quartile method,305 patients were divided into four groups:Q1,Q2,Q3 and Q4.The number of complications in the four groups was 50(65.8),30(39.5),23(30.3)and 11(14.3),showing a decreasing trend,with statistically significant differences between the groups(P<0.001).Correlation analysis showed that BMI was negatively correlated with glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,prothrombin time and postoperative hospital stay.BMI was positively correlated with serum albumin,and serum albumin increased with the increase of BMI.Patients were divided into complication group(n=114)and no complications group(n=191)according to complications.BMI was19.6±2.4 in the complication group and 22.0±3.2 in the no complications group,which was lower than that in the no complications group(P<0.001).Multivariate logistic regression analysis showed that age(OR=1.769,95%CI:1.319-2.371,P<0.001),neutrophil count(OR=1.910,95%CI:1.365-2.673,P<0.001),BMI(OR=0.308,95%CI:0.208-0.455,P<0.001),Child grade A(OR=0.399,95%CI:0.165-0.963,P=0.041),metastatic lesions(OR=2.230,95%CI:1.074-4.627,P=0.031),serum albumin(OR=1.092,95%CI:1.012-1.178,P=0.023),platelet(OR=1.004,95%CI:1.000-1.008,P=0.046),length of postoperative hospital stay(OR=1.158,95%CI:1.083-1.239,P<0.001)were independent predictors of complications.ROC analysis of BMI was performed.ROC analysis found that the area under the curve was 0.721(95%CI:0.663-0.779),and the optimal critical value was 20.67.After classifying BMI into binary variables of BMI<20.67 kg/m~2 and BMI≥20.67 kg/m~2,a multivariate Logistic regression model was established.After adjusting for potential confounding factors,the analysis OR values of five different Logistic regression models were4.725(95%CI:2.804-7.961),5.105(95%CI:2.955-8.818),5.318(95%CI:3.050-9.275),5.348(95%CI:2.988-9.571)and 5.235(95%CI:2.772-9.886),BMI<20.67 kg/m~2 was all P<0.05 in the five models with different confounding factors,suggesting that BMI<20.67 kg/m~2 was an independent risk factor for postoperative complications in patients with hepatic alveolar echinococcosis.The chapter three:210 patients with hepatic alveolar echinococcosis were divided into poor prognosis group(n=43)and favourable prognosis group(n=167)according to follow-up results.The poor outcome group had a lower BMI than the favourable prognosis group(18.5±1.8 vs.22.4±3.1,P<0.001).Serum albumin was(33.7±5.9)and neutrophil count was(4.1±1.5)and neutrophil count was(4.9±1.5),respectively,in the favourable prognosis group and the poor prognosis group(P<0.05).ROC analysis of BMI showed that the area under the curve was 0.881(95%CI:0.826-0.935),and the optimal threshold was 20.33.BMI was divided into binary variables according to the optimal threshold value of ROC diagnostic curve.Multivariate Cox regression analysis showed that BMI<20.33 kg/m~2(HR=26.575,95%CI:9.046-78.072,P<0.001),neutrophils(HR=1.326,95%CI:1.082-1.626,P=0.007)was an independent risk factor for poor prognosis after hepatectomy in patients with hepatic alveolar echinococcosis.Conclusion:The chapter two:(1)BMI was significantly reduced in patients with short-term complications following hepatectomy for hepatic alveolar echinococcosis.(2)BMI was negatively correlated with glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,prothrombin time and postoperative hospital stay,and positively correlated with serum albumin.(3)Univariate and multivariate Logistic regression models showed that BMI was an independent predictor of complications after hepatectomy for echinococcosis.(4)BMI analysis by ROC curve has high predictive value for short-term complications after hepatectomy for hepatic alveolar echinococcosis.(5)Multivariate Logistic regression analysis showed that BMI<20.67kg/㎡was an independent risk factor for short-term postoperative complications.The chapter three:(1)BMI level analyzed by ROC curve has high predictive value for long-term adverse prognosis of hepatic alveolar echinococcosis.(2)Multivariate Cox regression analysis showed that BMI<20.33 kg/m~2 and neutrophil elevation were independent risk factors for long-term adverse prognosis of patients with hepatic alveolar echinococcosis. |
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