Neutrophil to Lymphocyte Ratio and C-Reactive Protein as Two Predictive Tools of Anastomotic Leak in Colorectal Cancer Open Surgery

Abstract

Purpose: To assess the prognostic value of postoperative C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in the development of anastomotic leak (AL) in patients after surgery for colorectal cancer (CRC). Methods: Patients operated on for CRC between 2010 and 2014 were enrolled into the study. The sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPVs) were calculated for the CRP and NLR measured on the 4th postoperative day (POD). Results: Among 724 patients, AL was diagnosed in 33 (4.6%). The accuracy of CRP in the detection of AL using area under curve was 0.83 with the optimal cut-off value of 180 mg/L, sensitivity 75%, specificity 91%, PPV 52% and NPV 87%. Also, NLR on POD4 was higher in the AL group: 9.03 ± 4.13 vs. 4.45 ± 2.25; p = 0.0012; sensitivity 69%, specificity 78%, PPV 49%, NPV 88% at cut-off point of 6.5. Moreover, CRP and NLR on POD4 were significantly higher in patients who died in the postoperative period: 239 ± 24 mg/L vs. 199 ± 41 mg/L; p = 0.034 and 10.71 ± 2.08 vs. 8.65 ± 4.67; p = 0.029, respectively). Conclusions: CRP and NLR on POD4 possess the ability to predict the development of AL and postoperative mortality after CRC operation. Based on our results, high NPV might be indicative of patients with low risk of AL in their postoperative period.

The value of biomarkers in early diagnosis of anastomotic leak following colorectal tumor resection: a review of the literature between 2012 and 2017

“…NLR is another hot inflammation marker and it is also been assessed the prognostic value in the development of AL. The accuracy of NLR in the detection of AL using area under curve was 0.68 with the optimal cut-off value of 6.5, sensitivity 69%, specificity 78%, PPV 49% and NPV 88% [15]. According to this result, NLR on POD4 possesses the ability to predict the development of AL.…”

“…The cut-off value of 140 mg/L on POD3 maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage [6]. Serum CRP has been evaluated in other 11 studies [7][8][9][10][11][12][13][14][15][16][17]. In general, the CRP level was raised significantly days before the diagnosis of AL.…”

“…CRP (sensitivity 80%, specilficity 80% on POD3 and sensitivity 94%,specilficity 60% on POD4 in laparotomy); CRP (sensitivity 75%, specilficity 70% on POD2 in laparoscopy) Valentina, 2016, [14] PCT, CRP Negative predictive value Michal, 2017, [15] CRP (POD4, cutoff value:180 mg/L), NLR (POD4, cutoff value:6.5)…”

Predictive Values of C-Reactive Protein and Neutrophil to Lymphocyte Ratio in Detecting Anastomotic Leak in Open Colorectal Surgery

“…We read with interest the article entitled “Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) as 2 predictive tools on anastomotic leak (AL) in colorectal cancer open surgery” by Mik et al [1] recently published in Digestive Surgery. Among the 724 patients submitted to open colorectal surgery in the institutions involved in the study, 33 (4.6%) had an AL; the blood NLR and CRP values measured at the 4th postoperative day were significantly different in the groups of patients with and without AL.…”

“…The authors performed receiver operating characteristic curves to estimate the area under the curve (AUC) and evaluate the accuracy of the tests, at cut-off values assessed by the Youden test. In particular, at a CRP cut-off value of 180 mg/L, the AUC was 0.83 (good), the sensitivity 75%, the specificity 91%, the positive predictive value (PPV) 52%, and the negative predictive value (NPV) 87%; the corresponding figures for an NLR cut-off value of 6.5 at the 4th postoperative day were AUC 0.68 (poor), sensitivity 69%, specificity 78%, PPV 49%, and NPV 88% [1]. We recently performed a similar study and we obtained similar NLR AUC, sensitivity, and specificity values (data not yet published), but a consistently lower PPV.…”