Abstract:Objective To investigate the relationship between nutritional immune indicators and the occurrence of grade B pancreatic fistula after distal pancreatectomy. Methods A retrospective analysis was conducted on the clinical data of153 patients who underwent distal pancreatectomy at the Second Affiliated Hospital of Kunming Medical University from January 2017 to August 2023. According to the 2016 International Study Group on Pancreatic Surgery (ISGPS) grading system, the patients were divided into the pancreatic fistula group and the non-pancreatic fistula group. Clinical data were compared and analyzed between the two groups, and multivariate logistic regression analysis was performed. A nomogram was constructed and validated based on the results. Results Among the 153 patients, 33 developed grade B pancreatic fistula, with no case of grade C fistula. The pancreatic fistula group had a higher proportion of diabetes, alcohol consumption history, high BMI, and preoperative Controlling Nutritional Status (CONUT) score ≥3 compared to the non-pancreatic fistula group (P＜0.05). On postoperative day 1 and day 3, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were higher in the pancreatic fistula group than those in the non- pancreatic fistula group (P＜0.05). On postoperative day 3, total protein, Δalbumin, NLR, and PLR were also higher in the pancreatic fistula group compared to the non - pancreatic fistula group (P＜0.05). There were statistically significant differences between the two groups in terms of pancreatic CT values, pancreatic duct diameter, and intraoperative fluid infusion (P＜0.05). Multivariate logistic regression analysis showed that preoperative CONUT score (OR= 2.516, 95%CI: 1.477-4.286, P= 0.001), Δalbumin on postoperative day 3 (OR= 1.302, 95%CI: 1.089-1.556, P= 0.004), and pancreatic CT value (OR= 0.770, 95%CI: 0.669-0.887, P＜0.01) were independent risk factors for pancreatic fistula after distal pancreatectomy. The receiver operating characteristic (ROC) curve analysis revealed that the combined prediction of pancreatic fistula based on these three indicators had an area under the curve (AUC) of 0.950, sensitivity of 97.0%, and specificity of 88.3%, with good consistency in the nomogram and internal validation. Conclusion A high preoperative CONUT score, high Δalbumin on postoperative day 3, and low pancreatic CT value are risk factors for the occurrence of pancreatic fistula after distal pancreatectomy.