Prognostic Utility of the Preoperative Cachexia Index in Patients Undergoing Emergency Laparotomy

Emergency laparotomy is associated with high morbidity and mortality rates. The cachexia index, an objective index that incorporates muscle mass, nutrition, and inflammation, has been shown to predict outcomes in patients with cancer. The present study aimed to investigate the prognostic significance of preoperative cachexia index in patients undergoing emergency laparotomy.

This retrospective study included data from 404 patients who underwent emergency laparotomy between January 2013 and March 2023. The cachexia index was calculated as: (psoas muscle index × albumin level [g/dL]/neutrophil-to-lymphocyte ratio). Patients were divided into low and high cachexia index groups based on sex-specific receiver operating characteristic curve derived cut-off values.

Of 404 patients (median age, 74 years [44.6% female]), 120 (30%) exhibited a low cachexia index. In-hospital mortality was significantly higher in the low cachexia index group (20.0%) than that in the high cachexia index group (5.0%) (p < 0.01). Multivariate analysis revealed that age, chronic renal failure and cachexia index were independent predictors of in-hospital mortality. One-year mortality was also higher in the low versus high cachexia index group (34.2% vs. 13.4%, respectively; p < 0.01).

Preoperative cachexia index was a useful marker for predicting mortality after emergency laparotomy and may aid in risk stratification and perioperative decision-making.