An inflammation–nutrition composite index and its dynamic change for predicting postoperative wound complications
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Postoperative wound complications are an important cause of morbidity, and routinely available inflammatory markers may assist with early risk assessment. This study evaluated a newly proposed exploratory composite index, the Wound Inflammation-Nutrition Index (WINA), and its change between postoperative day 1 and postoperative day 3 (ΔWINA) in relation to postoperative wound complications. METHODS: This retrospective observational study included 86 patients who underwent general surgical procedures between January 2020 and December 2025. WINA was calculated by multiplying the C-reactive protein-to-albumin ratio by the neutrophil-to-lymphocyte ratio at postoperative days 1 and 3. ΔWINA was calculated as the POD3 value minus the POD1 value. Logistic regression, receiver operating characteristic analysis, model comparison, bootstrap internal validation, and sensitivity analyses were performed. RESULTS: Postoperative wound complications occurred in 24 patients (27.9%). WINA values at POD1 and POD3 and ΔWINA were higher in patients with wound complications (all p < 0.001). In the parsimonious multivariable model, ΔWINA per 100-unit increase was associated with wound complications (adjusted OR: 2.12, 95% CI: 1.44-3.13, p = 0.001), together with diabetes mellitus (adjusted OR: 2.89, 95% CI: 1.01-8.29, p = 0.048) and operative time per 30-minute increase (adjusted OR: 1.67, 95% CI: 1.08-2.58, p = 0.021). ΔWINA had an AUC of 0.872 (95% CI: 0.789-0.941), with 83.3% sensitivity, 80.6% specificity, 62.5% positive predictive value, and 92.6% negative predictive value at a cut-off of 245.0. Its discrimination did not differ significantly from WINA at POD3. Adding ΔWINA to the clinical model increased the AUC from 0.772 to 0.903 (ΔAUC: 0.131, p = 0.003). The association remained after excluding complications diagnosed on or before POD3. CONCLUSION: ΔWINA was associated with postoperative wound complications and improved the performance of a parsimonious clinical model. However, it did not outperform WINA measured at POD3, and the derived cut-off requires external validation before clinical use.
Source: Langenbeck s Archives of Surgery
Institutions: Bilecik Şeyh Edebali Üniversitesi, Düzce Üniversitesi
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
OpenAlex ID: W7204934313