The combined application of frailty index and prognostic nutritional index for short-term prognosis after colorectal surgery

objective Cooperative physiological reserve function is closely related to postoperative mortality and adverse outcome. Elderly patients with colorectal cancer should be performed preoperative geriatric assessment (CG). To construct a PNI-MFI-5 score system based on prognostic nutrition index (PNI) and modified debilitation index (MFI-5), to evaluate the elderly before operation and to explore the value of predicting poor prognosis after colorectal cancer operation. Methods 213 elderly patients who underwent radical resection of colorectal cancer were selected. The critical values of IPN and MFI-5 and their correlation were determined by receiver operating characteristic (ROC) curve, and the relationship between PNI-MFI-5 score and clinical parameters of colorectal cancer was analyzed. COX regression model was used to determine the relationship between PNI-MFI-5 score and postoperative poor prognosis, and ROC curve was used to determine the predictive efficiency of PNI-MFI-5. Results There was a significant correlation between preoperative PNI and preoperative MFI-5 score (r = -0.14, p < 0.05). The PNI-MFI scores increased significantly in advanced age (P < 0.003), ASA grade 3–4 (p < 0.001), preoperative anemia (p < 0.001), preoperative hypoproteinemia (p < 0.001) and tumor diameter ≥ 5cm (p < 0.001). A total of 73 patients had adverse outcome events, of which postoperative hypoproteinemia accounted for the highest proportion, followed by pulmonary infection. With each increase of grade, postoperative pulmonary infection (OR = 2.374,p < 0.001), anastomotic leakage (OR = 2.390,p < 0.001), septicemia (OR = 4.198,p < 0.001), hypoproteinemia (OR = 3.075, p < 0.001), cardio-cerebrovascular accident (OR = 3.742) occurred. The risk of postoperative adverse outcome events such as death at 30 days after operation (OR = 4.198,p < 0.05) increased. Further univariate and multivariate analysis showed that only PNI-MFI-5 score (OR = 2.540,95%CI 1.498–4.307 score pendant 0.001) was an independent predictor of adverse outcome events after CRC. The prediction efficiency of PNI-MFI-5 was higher, and the area under the curve of PNI-MFI-5 score (AUC = 0.724,P < 0.001) was larger than that of MFI-5 score (AUC = 0.678,95%CI 0.602–0.753 (P < 0.001) and PNI (AUC = 0.667,95%CI 0.585–0.748, P༜0.001). Conclusion The perioperative risk model of IPN-MFI-5 score system was constructed to accurately predict the risk of postoperative adverse outcome in patients with colorectal cancer.