The preoperative prognostic nutritional index is a prognostic indicator of postoperative pulmonary complications in patients with gynecological cancer

Abstract The prognostic nutritional index (PNI) reflects systemic inflammation and nutritional status. This study aimed to evaluate the predicting ability of the preoperative PNI regarding postoperative pulmonary complications (PPCs) in patients with gynecological cancer. Demographic, laboratory, and clinical data were retrospectively collected from 4887 patients who underwent gynecological cancer surgery. Preoperative PNIs were calculated from serum albumin levels and total lymphocyte counts. Primary outcome was PPCs, a composite outcome including acute respiratory distress syndrome, pneumonia, atelectasis, pleural effusion, and pneumothorax within postoperative day 15. An optimal cut-off value of 49.4 for the PNI score was determined using the receiver operating characteristic curve. The study used the stabilized inverse probability of treatment weighting (IPTW) method to reduce bias and compare between the high (n = 2898.5) and low PNI groups (n = 1290.4). The incidence of PPCs is significantly higher in the low PNI group than in the high PNI group (8.9% vs 17.0%, p < 0.001). In the multivariate logistic regression model after IPTW adjustment, a low preoperative PNI was an independent predictor of PPCs (odds ratio [95% confidence interval] 1.93 [1.53, 2.43], p < 0.001). Low preoperative PNIs are associated with PPCs in patients undergoing surgery for gynecologic cancer.