A nutrition-based nomogram for predicting intra-abdominal infection after D2 radical gastrectomy for gastric cancer

This study aims to construct a nutrition-based nomogram for predicting the risk of intra-abdominal infection (IAI) after D2 radical gastrectomy for gastric cancer (GC).

We retrospectively analyzed the clinical data of 404 individuals who received D2 radical gastrectomy for GC. Four preoperative nutrition-related indicators, the nutritional risk screening (NRS) 2002 score, albumin (ALB), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score, were collected and calculated. Multivariate logistic regression analysis was utilized to screen the independent risk factors for IAI following D2 radical gastrectomy for GC. The area under the receiver operating characteristics (ROC) curve (AUROC) was computed. A nomogram was established to forecast postoperative IAI using the independent risk factors.

The NRS2002 score, ALB, PNI, CONUT score, fasting blood glucose (FBG), American Society of Anesthesiologists (ASA) score, type of resection, multi-visceral resection, perioperative blood transfusion, and the tumor, node, metastasis (TNM) stage were significantly associated with postoperative IAI. Considering the collinearity between these nutrition-related variables, four multivariate logistic regression analyses were separately performed, and four independent nutrition-based models were constructed. Of these, the best one was the model based on the three indicators of NRS2002 score, FBG, and multi-visceral resection, which had an AUROC of 0.744 (0.657-0.830), with a specificity of 75.6% and a sensitivity of 62.9%. Further, a nomogram was constructed to estimate the probability of IAI following D2 radical gastrectomy. The internal validation was carried out using the bootstrap method with self-help repeated sampling 1000 times, and the concordance index (c-index) was determined at 0.742 (95% CI = 0.739-0.745). The calibration curve revealed that the predictive results of the nomogram were in excellent concordance with the actual observations. The decision curve analysis (DCA) indicates that the nomogram has excellent clinical benefit.

The nomogram constructed based on NRS2002 score, FBG, and multi-visceral resection has good predictive capacity for the incidence of IAI following D2 radical gastrectomy and provides a reference value for clinicians to assess the risk of IAI occurrence.