[Nutritional and immunological assessment in patients with malignant obstructive jaundice--the influence of...

A clinical study was undertaken to evaluate the nutritional and immunological status of patients with malignant obstructive jaundice with serum bilirubin level of 5mg/dl or greater (N = 22). Healthy volunteers (N = 9) and patients with cholecystolithiasis (N = 26) were assessed as non-icteric control, as well as patients with obstructive jaundice due to choledocholithiasis (N = 3) were used as icteric control. We also evaluated the time-course of five patients with malignant obstructive jaundice before and after PTCD and surgery. Nutritional status was assessed by prognostic nutritional index (PNI), blood chemistry and rapid turnover protein. Cellular and humoral immunity were assessed by peripheral lymphocyte count, lymphocyte stimulation test, antibody dependent cell-mediated cytotoxicity, and serum immunoglobulins. The following results were obtained. 1) Nutritional and immunological status of patients with malignant obstructive jaundice were severely depressed. 2) Nutritional and immunological status were not improved by preoperative biliary decompression such as PTCD. 3) The immunological indices recovered postoperatively. However, the nutritional indices did not recover by the time of discharge. Intensive nutritional support before and after surgery may be mandatory for patients with malignant obstructive jaundice.