Effect of metabolic syndrome on postoperative pulmonary infection in patients with colorectal cancer and construction of prediction model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DU Zhenzhen , HUA Xiaofan , LI Bin , QIAN Zhenghai

Department of General Surgery, Suzhou University Affiliated Suzhou Ninth Hospital, Suzhou, Jiangsu 215200, P. R. China;

Corresponding author：

DU Zhenzhen, Email: duzhenzhen1991@163.com

Keywords：

metabolic syndrome; pulmonary infection; colorectal cancer; influencing factors; prediction model

DOI：

10.7507/1007-9424.202412065

Video：

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Objective To explore the effect of metabolic syndrome (MS) on postoperative pulmonary infection in patients with colorectal cancer (CRC) and to construct a risk prediction model for postoperative pulmonary infection in CRC patients. Methods Retrospective collection of clinical data from 291 CRC patients who underwent surgical treatment at Suzhou Ninth Affiliated Hospital of Soochow University from January 2020 to August 2024. To explore the risk factors of postoperative pulmonary infection in patients with CRC and to establish a nomogram model. Results Among the 291 CRC patients enrolled, there were 58 MS patients (19.93%) and 233 non-MS patients (80.07%). Compared with patients without MS, CRC patients with MS had longer surgery time and higher incidence of postoperative pulmonary infection (P<0.05). The results of multiple logistic regression analysis showed that smoking history, body mass index (BMI)≥25 kg/m², MS, increased surgical time and increased intraoperative bleeding were all risk factors for postoperative pulmonary infection in CRC patients (P<0.05). Based on these risk factors, a nomogram model was constructed. The area under the receiver operating characteristic curve was 0.845 [95%CI (0.769, 0.906)], and the sensitivity and specificity were 84.2% and 87.5% respectively. The internal verification of Bootstrap test showed that the simulated curve and the actual curve had good consistency. The clinical decision curve analysis shows that when the threshold probability is in the range of 8–84%, the net benefit of the model for patient diagnosis is higher. Conclusions MS increases the risk of postoperative pulmonary infection in CRC patients. At the same time, smoking history, high BMI, long operation time, and more intraoperative blood loss are also risk factors for postoperative pulmonary infection in patients with CRC. Building a model based on this can effectively evaluate the risk of postoperative pulmonary infection in CRC patients.

1.	王锡山. 从中美结直肠癌流行病学特征看结直肠癌早诊早治的重要性. 中华结直肠疾病电子杂志, 2021, 10(1): 26-33.
2.	Feng R, Su Q, Huang X, et al. Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration?. Cancer Commun (Lond), 2023, 43(1): 75-86.
3.	邓洁莲, 李康杰, 张聪, 等. 基于转录组数据识别代谢综合征与结直肠癌的共同基因特征和分子机制. 重庆医科大学学报, 2023, 48(12): 1514-1519.
4.	Shariq OA, Hanson KT, McKenna NP, et al. Does metabolic syndrome increase the risk of postoperative complications in patients undergoing colorectal cancer surgery?. Dis Colon Rectum, 2019, 62(7): 849-858.
5.	龚熙, 陆叶青, 吴秀芳, 等. 腹腔镜结直肠癌手术患者并发症影响因素分析. 中国医药导报, 2023, 20(17): 123-126.
6.	邵拥军, 李恒, 沈国栋, 等. 老年结直肠癌患者术后并发症危险因素分析. 中国临床保健杂志, 2023, 26(6): 824-827.
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8.	Smith M, Honce R, Schultz-Cherry S. Metabolic syndrome and viral pathogenesis: lessons from influenza and coronaviruses. J Virol, 2020, 94(18): e00665-620. doi: 10.1128/JVI.00665-20.
9.	上海市抗癌协会大肠癌专业委员会. 结直肠癌早筛、早诊、早治上海方案 (2023年版). 中国癌症杂志, 2024, 34(1): 13-65.
10.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南 (2020年版)(下). 中国实用内科杂志, 2021, 41(9): 757-784.
11.	Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111. doi: 10.1093/cid/ciw353.
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13.	Lu B, Qian JM, Li JN. The metabolic syndrome and its components as prognostic factors in colorectal cancer: a meta-analysis and systematic review. J Gastroenterol Hepatol, 2023, 38(2): 187-196.
14.	金剑, 廖欣, 杨庆强. 合并代谢综合征的结直肠癌患者术后腹腔感染风险的预测模型构建与验证. 现代肿瘤医学, 2024, 32(18): 3494-3501.
15.	钟洁, 贺育华, 蒋理立, 等. 腹腔镜结直肠癌手术患者术后肺部感染相关因素分析. 中国普外基础与临床杂志, 2022, 29(8): 1048-1053.
16.	靳英, 付小霞, 段霄杰, 等. 代谢综合征与胃癌患者临床病理特征的关系. 肿瘤研究与临床, 2021, 33(11): 853-856.
17.	Shaw M, Waiting J, Barraclough L, et al. Airway events in obese vs. non-obese elective surgical patients: a cross-sectional observational study. Anaesthesia, 2021, 76(12): 1585-1592.
18.	刘瞻, 赵英丽, 陈晓婷. 维生素D水平与2型糖尿病并发肺部感染患者免疫功能及其预后的关系. 中华医院感染学杂志, 2022, 32(9): 1295-1298.
19.	王太行, 李慧娴, 李宝利, 等. 肥胖对腹腔镜结直肠癌根治术后肺部并发症的影响. 中华医学杂志, 2024, 104(18): 1610-1616.
20.	Peters U, Suratt BT, Bates JHT, et al. Beyond BMI: obesity and lung disease. Chest, 2018, 153(3): 702-709.
21.	Duran M, Ziyrek M. Effect of Obesity on pulmonary vascular hemodynamics. J Cardiovasc Echogr, 2020, 30(2): 75-81.
22.	杨刚, 张乐杨, 周雨迪, 等. 代谢综合征及其组份与结直肠癌根治术后短期预后的相关性. 中国肿瘤临床, 2022, 49(19): 982-987.
23.	刘勇, 杨猎龙, 汪晓东, 等. BMI可影响结直肠癌患者术前内外科合并症状态: 基于DACCA的真实世界数据研究. 中国普外基础与临床杂志, 2021, 28(12): 1637-1644.
24.	Wang J, Zhu L, Liu L, et al. Clinical features and prognosis of COVID-19 patients with metabolic syndrome: a multicenter, retrospective study. Med Clin (Barc), 2022, 158(10): 458-465.
25.	Tao NN, Li YF, Song WM, et al. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004-2019. BMJ Open, 2021, 11(6): e044349. doi: 10.1136/bmjopen-2020-044349.
26.	景丽萍, 王棣, 殷艳, 等. IL-10基因多态性与结直肠癌根治术后肺部感染程度的关联. 中华医院感染学杂志, 2023, 33(19): 2949-2952.
27.	庄丽红, 董扬扬, 李新宇, 等. 2015–2019年398例老年大肠癌患者术后肺部感染情况及危险因素. 中华医院感染学杂志, 2021, 31(17): 2702-2706.

1. 王锡山. 从中美结直肠癌流行病学特征看结直肠癌早诊早治的重要性. 中华结直肠疾病电子杂志, 2021, 10(1): 26-33.
2. Feng R, Su Q, Huang X, et al. Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration?. Cancer Commun (Lond), 2023, 43(1): 75-86.
3. 邓洁莲, 李康杰, 张聪, 等. 基于转录组数据识别代谢综合征与结直肠癌的共同基因特征和分子机制. 重庆医科大学学报, 2023, 48(12): 1514-1519.
4. Shariq OA, Hanson KT, McKenna NP, et al. Does metabolic syndrome increase the risk of postoperative complications in patients undergoing colorectal cancer surgery?. Dis Colon Rectum, 2019, 62(7): 849-858.
5. 龚熙, 陆叶青, 吴秀芳, 等. 腹腔镜结直肠癌手术患者并发症影响因素分析. 中国医药导报, 2023, 20(17): 123-126.
6. 邵拥军, 李恒, 沈国栋, 等. 老年结直肠癌患者术后并发症危险因素分析. 中国临床保健杂志, 2023, 26(6): 824-827.
7. Szilveszter M, Pál S, Simon-Szabó Z, et al. The management of COVID-19-related coagulopathy: a focus on the challenges of metabolic and vascular diseases. Int J Mol Sci, 2023, 24(16): 12782. doi: 10.3390/ijms241612782.
8. Smith M, Honce R, Schultz-Cherry S. Metabolic syndrome and viral pathogenesis: lessons from influenza and coronaviruses. J Virol, 2020, 94(18): e00665-620. doi: 10.1128/JVI.00665-20.
9. 上海市抗癌协会大肠癌专业委员会. 结直肠癌早筛、早诊、早治上海方案 (2023年版). 中国癌症杂志, 2024, 34(1): 13-65.
10. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南 (2020年版)(下). 中国实用内科杂志, 2021, 41(9): 757-784.
11. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111. doi: 10.1093/cid/ciw353.
12. Yao F, Bo Y, Zhao L, et al. Prevalence and influencing factors of metabolic syndrome among adults in China from 2015 to 2017. Nutrients, 2021, 13(12): 4475. doi: 10.3390/nu13124475.
13. Lu B, Qian JM, Li JN. The metabolic syndrome and its components as prognostic factors in colorectal cancer: a meta-analysis and systematic review. J Gastroenterol Hepatol, 2023, 38(2): 187-196.
14. 金剑, 廖欣, 杨庆强. 合并代谢综合征的结直肠癌患者术后腹腔感染风险的预测模型构建与验证. 现代肿瘤医学, 2024, 32(18): 3494-3501.
15. 钟洁, 贺育华, 蒋理立, 等. 腹腔镜结直肠癌手术患者术后肺部感染相关因素分析. 中国普外基础与临床杂志, 2022, 29(8): 1048-1053.
16. 靳英, 付小霞, 段霄杰, 等. 代谢综合征与胃癌患者临床病理特征的关系. 肿瘤研究与临床, 2021, 33(11): 853-856.
17. Shaw M, Waiting J, Barraclough L, et al. Airway events in obese vs. non-obese elective surgical patients: a cross-sectional observational study. Anaesthesia, 2021, 76(12): 1585-1592.
18. 刘瞻, 赵英丽, 陈晓婷. 维生素D水平与2型糖尿病并发肺部感染患者免疫功能及其预后的关系. 中华医院感染学杂志, 2022, 32(9): 1295-1298.
19. 王太行, 李慧娴, 李宝利, 等. 肥胖对腹腔镜结直肠癌根治术后肺部并发症的影响. 中华医学杂志, 2024, 104(18): 1610-1616.
20. Peters U, Suratt BT, Bates JHT, et al. Beyond BMI: obesity and lung disease. Chest, 2018, 153(3): 702-709.
21. Duran M, Ziyrek M. Effect of Obesity on pulmonary vascular hemodynamics. J Cardiovasc Echogr, 2020, 30(2): 75-81.
22. 杨刚, 张乐杨, 周雨迪, 等. 代谢综合征及其组份与结直肠癌根治术后短期预后的相关性. 中国肿瘤临床, 2022, 49(19): 982-987.
23. 刘勇, 杨猎龙, 汪晓东, 等. BMI可影响结直肠癌患者术前内外科合并症状态: 基于DACCA的真实世界数据研究. 中国普外基础与临床杂志, 2021, 28(12): 1637-1644.
24. Wang J, Zhu L, Liu L, et al. Clinical features and prognosis of COVID-19 patients with metabolic syndrome: a multicenter, retrospective study. Med Clin (Barc), 2022, 158(10): 458-465.
25. Tao NN, Li YF, Song WM, et al. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004-2019. BMJ Open, 2021, 11(6): e044349. doi: 10.1136/bmjopen-2020-044349.
26. 景丽萍, 王棣, 殷艳, 等. IL-10基因多态性与结直肠癌根治术后肺部感染程度的关联. 中华医院感染学杂志, 2023, 33(19): 2949-2952.
27. 庄丽红, 董扬扬, 李新宇, 等. 2015–2019年398例老年大肠癌患者术后肺部感染情况及危险因素. 中华医院感染学杂志, 2021, 31(17): 2702-2706.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesEffect of metabolic syndrome on postoperative pulmonary infection in patients with colorectal cancer and construction of prediction model

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