Platelet to Lymphocyte Ratio Associated with Prolonged Hospital Length of Stay Postpeptic Ulcer Perforation Repair: An Observational Descriptive Analysis

Abstract

Background. The predictive role of platelet to lymphocyte ratio (P/LR) in patients with perforated peptic ulcer (PPU) is not well-studied. We aimed to investigate the association between the P/LR ratio and the hospital length of stay (HLOS) for surgically treated PPU. Method. This is a retrospective observational study for surgically treated adult cases of PPU at Hamad Medical Corporation during the period from January 2012 to August 2017. Patients were categorized into two groups based on their HLOS (<I week vs. >I week). The receiver operating characteristic (ROC) curve was plotted to determine the cutoff value for lymphocyte count, neutrophil to lymphocyte ratio, and P/LR ratio for predicting the prolonged hospitalization. Results. One hundred and fifty-two patients were included in the study. The majority were young males. The mean age was 38.3 ± 12.7 years. Perforated duodenal ulcer (139 patients) exceeded perforated gastric ulcer (13 patients). The HLOS > 1 week was observed in 14.5% of cases. Older age ( p = 0.01 ), higher preoperative WBC ( p = 0.03 ), lower lymphocyte count ( p = 0.01 ), and higher P/LR ratio ( p = 0.005 ) were evident in the HLOS > 1 week group. The optimal cutoff value of P/LR was 311.2 with AUC 0.702 and negative predictive value of 93% for the prediction of prolonged hospitalization. Two patients died with a mean P/LR ratio of 640.8 ± 135.5 vs. 336.6 ± 258.9 in the survivors. Conclusion. High preoperative P/LR value predicts prolonged HLOS in patients with repaired perforated peptic ulcer. Further larger multicenter studies are needed to support the study findings.

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

“…Interestingly, a study by Al-Yahiri et al describes an association between a higher pre-procedural platelet to lymphocyte ratio and increased length of hospitalization post-repair, as well as increased mortality for patients with perforated duodenal ulcers. 20 This supports the idea that individual variations in patient factors, including differences in inflammatory biomarkers and immune response, particularly in elderly patients who have slowed cellular immunity, influence HLOS and can contribute to poorer outcomes. Early detection and definitive treatment are essential keys to improving mortality outcomes in patients admitted with chronic DUs.…”

Platelet-Lymphocyte and Neutrophil-Lymphocyte Ratio for Prediction of Hospital Outcomes in Patients with Abdominal Trauma

“…The PLR and NLR could reflect the inflammatory, immunity, and hemostatic status in acute illnesses [17][18][19][20]. To the best of our knowledge, this is the first study to evaluate the prognostic value of PLR and NLR in patients with abdominal trauma.…”

“…The postoperative NLR value of 9.9 was associated with the occurrence of AKI with a sensitivity of 80% and specificity of 81%, while the PLR value of 22.8 had sensitivity of 80% and specificity of 83%. Our prior work showed that in patients with repaired perforated peptic ulcer, the optimal cutoff value of PLR was 311.2 with AUC 0.702 and negative predictive value of 93% for the prediction of prolonged hospitalization (>1 week) [17].…”

“…Lymphocytes are the major cellular components of the humoral and cell-mediated immune system which include T, B, and natural killer cells [15]. Platelets, as a contributor to the inflammatory response, and platelet-associated chemokines such as platelet factor 4 and connective tissueactivating peptide III can modulate the inflammation process; however, low lymphocyte counts may lead to inadequate immune responses [16,17].…”

“…The neutrophil and lymphocyte counts are expected to increase or decrease in the stressful and systemic inflammation conditions such as trauma and surgical interventions [17][18][19][20]. Furthermore, the platelet-to-lymphocyte ratio (PLR) could reflect the balance between the body response to inflammation and immunity mediators [16,17].…”