Neutrophil-to-lymphocyte ratio vs C-reactive protein as early predictors of anastomotic leakage after colorectal surgery: A retrospective cohort study

Pachajoa, Diana A. Pantoja; Gielis, Manuel; Huatuco, René M. Palacios; Benitez, Milagros N.; Avila, Micaela; Doniquian, Alejandro M.; Alvarez, Fernando A.; Parodi, Matías

doi:10.1016/j.amsu.2021.102201

Cited by 10 publications

(14 citation statements)

References 24 publications

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“…In addition to HGB, HTC and RDW levels, NLR has also taken its place in older adults surgery patients in the literature, but as with other hemogram parameters, the prognosis was evaluated only in operated patients. In a study examining the development of anastomotic leakage after colorectal surgery, no statistical significance was found between the NLR level and the development of anastomotic leakage (12). The results of our study revealed a positive correlation between NLR and LOHS in all patient groups, regardless of operation status, and there was a significant correlation between the level of this parameter and mortality.…”

Section: Discussioncontrasting

confidence: 84%

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

Akça¹,

Algın²,

Özdemir³

et al. 2022

Journal of Health Sciences and Medicine

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Aim:We aimed to investigate the effects of hemogram parameters on the short-term mortality of older adults with acute abdominal pathologies. Secondly, it was aimed to investigate the effect of hemogram parameters on mortality in operated and non-operated patients. Material and Method: This retrospective observational study was conducted in an emergency medicine clinic between June 1, 2019, and June 1, 2020. Data on patients over 65 years of age who presented to the emergency department with acute abdominal pathologies were analyzed. Hemogram parameters, as in our patient group over 65 years old, who presented with all acute abdomen pathologies; It was examined in terms of its relationship with prognosis in our operated and non-operated patient group. Statistical analysis was performed using SPSS v. 26.0. Results:The study included a total of 744 patients, of whom 391(52.6%) were women. Mortality was seen in 114(15.32%) patients, and 83(11.2%) patients underwent surgery. AUC and cut off values are for leukocytes count 0.590 and 10.83 for neutrophils count 0.596 and 9.64 for neutrophil-lymphocyte ratio 0.606 and 8.24 to predict mortality (p=0.002, p=0.001, and p>0.001, respectively Conclusion: In this study, among the hemogram parameters; leukocytes, neutrophils and neutrophil-lymphocyte ratio were determined to have a statistically significant ability to predict mortality in older adults both operaple and non operabl groups groups presenting with acute abdominal pathologies, but their accuracy rates were low.

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Section: Discussioncontrasting

confidence: 84%

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

Akça¹,

Algın²,

Özdemir³

et al. 2022

Journal of Health Sciences and Medicine

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“…1. Fifteen studies (12)(13)(14)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) met the defined inclusion criteria and had adequate data to be included in the meta-analysis.…”

Section: Results Resultsmentioning

confidence: 99%

“…Eight studies (12,(23)(24)(25)(26)28,30,34) reported measuring CRP routinely during the postoperative period, whereas the other seven (13,14,27,29,(31)(32)(33) did not have CRP data available for all patients on each day. Only two studies (28,30) measured PCT daily in the postoperative period, and four studies (12,24,28,34) had WBC count data available daily after surgery. Only one study (29) reported blinding of surgeons to the results of CRP assays.…”

Section: Results Resultsmentioning

confidence: 99%

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The Usefulness of Inflammatory Biomarkers to Predict Anastomotic Leakage after Colorectal Surgery: Systematic Review and Meta-Analysis

Rama¹,

Lages²,

Silva³

et al. 2022

SGO

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Aim: Anastomotic leakage (AL) is a severe postoperative complication in colorectal surgery, but its preclinical diagnosis may improve outcomes and increase anastomotic salvage. This study aimed to assess the added value of serum biomarkers for early detection of colorectal AL. Method: We performed a comprehensive literature review, and a qualitative and quantitative analysis of papers retrieved from MEDLINE, Embase, PubMed, Web of Science, Scopus and the Cochrane Library. We included all studies published before September 2021 assessing the serum biomarkers white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT) and calprotectin (CLP) for the early diagnosis of AL. Results: Fifteen studies that evaluated three different systemic biomarkers in the context of AL were identified, including 5150 patients. Diagnostic test accuracy was estimated for CRP and PCT. On postoperative day (POD) 5, the highest AUC (87.1%) and specificity (80.2%) values were estimated for CRP. Random-effects meta-analysis and total effect sizes estimation for the biomarkers CRP, PCT and WBC were performed according to POD. The concentration of serum biomarkers is significantly higher in patients presenting AL. Regarding the qualitative analysis, there was significant heterogeneity in the inclusion of different subcategories of the consensus definition of colorectal AL in each paper's definition. Conclusion:The serum biomarkers CRP and PCT are moderate predictors for AL, showing a high heterogeneity among the studies. Combinations of these biomarkers might improve predictive accuracy, but more studies will be necessary to conduct a quality metaregression.

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“…Therefore, the elevated NLR levels can be used as an important marker of inflammation and are more reliable than calculating neutrophils or lymphocytes alone [ 19 ]. A retrospective study by Diana et al with a small sample size (116 patients) reported that no statistical difference was found in the NLR levels between patients with and without AL in the first 5 postoperative days [ 20 ]. However, the largest multicenter study by Paliogiannis et al included 1,432 patients and demonstrated that the postoperative NLR cut-off score of 7.1 showed the best efficacy in AL prediction (AUC: 0.744, 95% CI: 0.719–0.768), with the sensitivity and specificity of 72.73% and 73.44%, respectively [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Symptomatic Anastomotic Leakage in Patients after Rectal Cancer Surgery: A Propensity Score-Matched Analysis

Tan

et al. 2022

JPM

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Background: This study aimed to explore the role of postoperative neutrophil-to-lymphocyte ratio in predicting symptomatic anastomotic leakage in patients who underwent laparoscopic low anterior resection for rectal cancer. Methods: In this retrospective cohort study, we analyzed data of patients who underwent laparoscopic low anterior resection from May 2009 to May 2019. A receiver operating characteristic curve analysis was performed to evaluate the cut-off values with the best predictive efficacy of a symptomatic anastomotic leakage. In addition, a propensity score-matched analysis was performed by considering all covariate variables, and 61 patients with or without symptomatic anastomotic leakage were included in the analysis. Results: The present study included 306 patients; of these, 17 (5.56%) developed symptomatic anastomotic leakage after surgery. On postoperative day 5, compared with patients without symptomatic anastomotic leakage, those with leakage had significantly higher neutrophil-to-lymphocyte levels. Notably, a neutrophil-to-lymphocyte cut-off score of 6.54 indicated the best area under the curve of 0.818 (95% confidence interval: 0.697–0.940, p < 0.001) in predicting symptomatic anastomotic leakage, with a sensitivity and specificity of 76.5% and 79.4%, respectively. Conclusions: Although evidence for the predictive role of neutrophil-to-lymphocyte ratio is accumulating, it remains inconclusive. In addition, neutrophil-to-lymphocyte levels should be considered a predictive biomarker for symptomatic anastomotic leakage; however, it can more accurately be viewed as an adjunct that helps increase the clinical suspicion of emerging symptomatic anastomotic leakage.

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Neutrophil-to-lymphocyte ratio vs C-reactive protein as early predictors of anastomotic leakage after colorectal surgery: A retrospective cohort study

Cited by 10 publications

References 24 publications

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

The Usefulness of Inflammatory Biomarkers to Predict Anastomotic Leakage after Colorectal Surgery: Systematic Review and Meta-Analysis

Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Symptomatic Anastomotic Leakage in Patients after Rectal Cancer Surgery: A Propensity Score-Matched Analysis

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