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 Ninth People’s Hospital, Suzhou, Jiangsu 215200, P. R. China;

Corresponding?author：

DU Zhenzhen, Email: duzhenzhen1991@163.com

Keywords：

metabolic syndrome; pulmonary infection; colorectal cancer; influencing factor; 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 Department of General Surgery, Suzhou Ninth People’s Hospital in the period of 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 (P<0.001) and higher incidence of postoperative pulmonary infection (P<0.001). The results of multiple logistic regression analysis showed that smoking history [OR=2.184, 95%CI (1.097, 4.345), P=0.026], body mass index (BMI)≥25 kg/m² [OR=2.662, 95%CI (1.241, 5.703), P=0.012], MS [OR=2.770, 95%CI (1.415, 5.425), P=0.003], increased surgical time [OR=4.039, 95%CI (1.774, 9.197), P<0.001] and increased intraoperative bleeding [OR=2.398, 95%CI (1.246, 4.618), P=0.009] were all risk factors for postoperative pulmonary infection in CRC patients. Based on these risk factors, a nomogram model was constructed. The area under the curve (AUC) 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 showed that when the threshold probability was in the range of 8%–84%, the net benefit of the model for patient diagnosis was higher. Conclusions MS increases the risk of postoperative pulmonary infection in CRC patients. At the same time, smoking history, BMI≥25 kg/m², 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.

Citation： DU Zhenzhen, HUA Xiaofan, LI Bin, QIAN Zhenghai. 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, 2025, 32(10): 1318-1323. doi: 10.7507/1007-9424.202412065 Copy

1.	王錫山. 從中美結直腸癌流行病學特征看結直腸癌早診早治的重要性. 中華結直腸疾病電子雜志, 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.	鄧潔蓮, 李康杰, 張聰, 等. 基于轉錄組數據識別代謝綜合征與結直腸癌的共同基因特征和分子機制. 重慶醫科大學學報, 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.	龔熙, 陸葉青, 吳秀芳, 等. 腹腔鏡結直腸癌手術患者并發癥影響因素分析. 中國醫藥導報, 2023, 20(17): 123-126.
6.	邵擁軍, 李恒, 沈國棟, 等. 老年結直腸癌患者術后并發癥危險因素分析. 中國臨床保健雜志, 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.	上海市抗癌協會大腸癌專業委員會. 結直腸癌早篩、早診、早治上海方案 (2023年版). 中國癌癥雜志, 2024, 34(1): 13-65.
10.	中華醫學會糖尿病學分會. 中國2型糖尿病防治指南 (2020年版)(下). 中國實用內科雜志, 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.	金劍, 廖欣, 楊慶強. 合并代謝綜合征的結直腸癌患者術后腹腔感染風險的預測模型構建與驗證. 現代腫瘤醫學, 2024, 32(18): 3494-3501.
15.	鐘潔, 賀育華, 蔣理立, 等. 腹腔鏡結直腸癌手術患者術后肺部感染相關因素分析. 中國普外基礎與臨床雜志, 2022, 29(8): 1048-1053.
16.	靳英, 付小霞, 段霄杰, 等. 代謝綜合征與胃癌患者臨床病理特征的關系. 腫瘤研究與臨床, 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.	劉瞻, 趙英麗, 陳曉婷. 維生素D水平與2型糖尿病并發肺部感染患者免疫功能及其預后的關系. 中華醫院感染學雜志, 2022, 32(9): 1295-1298.
19.	王太行, 李慧嫻, 李寶利, 等. 肥胖對腹腔鏡結直腸癌根治術后肺部并發癥的影響. 中華醫學雜志, 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.	楊剛, 張樂楊, 周雨迪, 等. 代謝綜合征及其組份與結直腸癌根治術后短期預后的相關性. 中國腫瘤臨床, 2022, 49(19): 982-987.
23.	劉勇, 楊獵龍, 汪曉東, 等. BMI可影響結直腸癌患者術前內外科合并癥狀態: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 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.	景麗萍, 王棣, 殷艷, 等. IL-10基因多態性與結直腸癌根治術后肺部感染程度的關聯. 中華醫院感染學雜志, 2023, 33(19): 2949-2952.
27.	莊麗紅, 董揚揚, 李新宇, 等. 2015–2019年398例老年大腸癌患者術后肺部感染情況及危險因素. 中華醫院感染學雜志, 2021, 31(17): 2702-2706.

1. 王錫山. 從中美結直腸癌流行病學特征看結直腸癌早診早治的重要性. 中華結直腸疾病電子雜志, 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. 鄧潔蓮, 李康杰, 張聰, 等. 基于轉錄組數據識別代謝綜合征與結直腸癌的共同基因特征和分子機制. 重慶醫科大學學報, 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. 龔熙, 陸葉青, 吳秀芳, 等. 腹腔鏡結直腸癌手術患者并發癥影響因素分析. 中國醫藥導報, 2023, 20(17): 123-126.
6. 邵擁軍, 李恒, 沈國棟, 等. 老年結直腸癌患者術后并發癥危險因素分析. 中國臨床保健雜志, 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. 上海市抗癌協會大腸癌專業委員會. 結直腸癌早篩、早診、早治上海方案 (2023年版). 中國癌癥雜志, 2024, 34(1): 13-65.
10. 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南 (2020年版)(下). 中國實用內科雜志, 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. 金劍, 廖欣, 楊慶強. 合并代謝綜合征的結直腸癌患者術后腹腔感染風險的預測模型構建與驗證. 現代腫瘤醫學, 2024, 32(18): 3494-3501.
15. 鐘潔, 賀育華, 蔣理立, 等. 腹腔鏡結直腸癌手術患者術后肺部感染相關因素分析. 中國普外基礎與臨床雜志, 2022, 29(8): 1048-1053.
16. 靳英, 付小霞, 段霄杰, 等. 代謝綜合征與胃癌患者臨床病理特征的關系. 腫瘤研究與臨床, 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. 劉瞻, 趙英麗, 陳曉婷. 維生素D水平與2型糖尿病并發肺部感染患者免疫功能及其預后的關系. 中華醫院感染學雜志, 2022, 32(9): 1295-1298.
19. 王太行, 李慧嫻, 李寶利, 等. 肥胖對腹腔鏡結直腸癌根治術后肺部并發癥的影響. 中華醫學雜志, 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. 楊剛, 張樂楊, 周雨迪, 等. 代謝綜合征及其組份與結直腸癌根治術后短期預后的相關性. 中國腫瘤臨床, 2022, 49(19): 982-987.
23. 劉勇, 楊獵龍, 汪曉東, 等. BMI可影響結直腸癌患者術前內外科合并癥狀態: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 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. 景麗萍, 王棣, 殷艷, 等. IL-10基因多態性與結直腸癌根治術后肺部感染程度的關聯. 中華醫院感染學雜志, 2023, 33(19): 2949-2952.
27. 莊麗紅, 董揚揚, 李新宇, 等. 2015–2019年398例老年大腸癌患者術后肺部感染情況及危險因素. 中華醫院感染學雜志, 2021, 31(17): 2702-2706.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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