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Shevchenko I, Serban D, Simion L, Motofei I, Cristea BM, Dumitrescu D, Tudor C, Dascalu AM, Serboiu C, Tribus LC, Marin A, Silaghi AM, Costea DO. Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review. J Clin Med 2025; 14:2529. [PMID: 40217978 PMCID: PMC11989995 DOI: 10.3390/jcm14072529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 03/28/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer.
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Affiliation(s)
- Irina Shevchenko
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laurentiu Simion
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Department of Surgical Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Department of Surgery, “Sf. Pantelimon” Emergency Hospital, 021659 Bucharest, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
| | - Dan Dumitrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Gastroenterology, Ilfov Clinic Hospital, 022104 Bucharest, Romania
| | - Andrei Marin
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (D.D.)
- Plastic Surgery Department, “Sf. Ioan” Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Adrian Marius Silaghi
- Department of Surgery, “Sf. Pantelimon” Emergency Hospital, 021659 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of General Surgery, Emergency County Clinic Hospital, 900591 Constanta, Romania
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Hurley R, Osbourne J, Inman GJ, Conway DI, Paterson C, Douglas CM. Pre-Treatment Serum Prognostic Scores and Survival in Curatively Treated Laryngeal Cancer. Laryngoscope Investig Otolaryngol 2025; 10:e70124. [PMID: 40124253 PMCID: PMC11929121 DOI: 10.1002/lio2.70124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 03/02/2025] [Indexed: 03/25/2025] Open
Abstract
Background Laryngeal squamous cell cancer (LSCC) is a common head and neck cancer subtype, primarily linked to smoking and alcohol use. Despite declining incidence, survival outcomes have not improved. Prognostic scores, derived from blood-based markers like neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SIII), are increasingly recognized for their potential to predict survival outcomes and guide patient management. Methods A retrospective analysis of 473 LSCC patients diagnosed in the West of Scotland (2014-2020) assessed the association of prognostic scores with overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Patients were categorized into high- and low-risk groups based on combined scores. Results Low LMR and high-risk scores were significantly associated with worse OS, CSS, and RFS. Nodal status and disease stage remained strong predictors. Combining clinicopathological variables with prognostic scores improved survival prediction. Conclusion Prognostic scores are valuable tools for survival prediction in LSCC and, when combined with clinicopathological factors, may guide patient management. Further validation is warranted.
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Affiliation(s)
- Rhona Hurley
- School of Cancer Sciences, Garscube Estate, University of GlasgowGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
- Department of Otolaryngology/Head and Neck Surgery – Glasgow Royal Infirmary and Queen Elizabeth University HospitalGlasgowUK
- Cancer Research UK Scotland InstituteGarscube EstateGlasgowUK
| | - James Osbourne
- School of Medicine, Dentistry and Nursing, University of GlasgowGlasgowUK
| | - Gareth J. Inman
- School of Cancer Sciences, Garscube Estate, University of GlasgowGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
- Cancer Research UK Scotland InstituteGarscube EstateGlasgowUK
| | - David I. Conway
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
- School of Medicine, Dentistry and Nursing, University of GlasgowGlasgowUK
| | - Claire Paterson
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
- School of Medicine, Dentistry and Nursing, University of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
| | - Catriona M. Douglas
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
- Department of Otolaryngology/Head and Neck Surgery – Glasgow Royal Infirmary and Queen Elizabeth University HospitalGlasgowUK
- School of Medicine, Dentistry and Nursing, University of GlasgowGlasgowUK
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Petit L, Pastene B, Dupont G, Baffeleuf B, Goulevant PA, Fellahi JL, Gricourt Y, Lebuffe G, Ouattara A, Fischer MO, Mertes PM, Eyraud D, Bouhemad B, Gomola A, Montravers P, Alingrin J, Flory L, Incagnoli P, Boisson M, Leone M, Monneret G, Lukaszewicz AC, Pereira B, Molliex S. Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study). Eur J Anaesthesiol 2025; 42:244-254. [PMID: 39474711 DOI: 10.1097/eja.0000000000002089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
BACKGROUND Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs). OBJECTIVES We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence. STUDY DESIGN The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia. SETTING Patients were included from January 2016 to September 2017 in 25 French centres. PATIENTS Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion. MAIN OUTCOME MEASURE PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy). RESULTS Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time ( P = 0.001) but not with preoperative LC ( P = 0.536).POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors. CONCLUSIONS POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02799251.
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Affiliation(s)
- Ludivine Petit
- From the Département d'Anesthésie-Réanimation, Université Jean Monnet Saint Etienne, CHU Saint Etienne, F-42023, Saint Etienne, France (LP, GD, LF SM), the Service d'Anesthésie et de Réanimation, Université d'Aix Marseille, Assistance Publique Hôpitaux de Marseille,, Hôpital Nord, Marseille, France (BP, JA, ML), the Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France (BB, PI), the Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86021, France; Inserm U1070, Université de Poitiers, Poitiers, France (PAG, MB), the Service d'Anesthésie et de Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, 69500, Lyon, France (JLF), the Département Anesthésie et Réanimation, Centre Hospitalier Universitaire Nîmes, Nîmes, France (YG), the Service d'Anesthésie, Centre hospitalier et universitaire de Lille, F-59037 Lille, France (GL), the Service Anesthésie et Réanimation, Centre Medico-chirurgical Magellan, Centre Hospitalier Universitaire de Bordeaux, Pessac, France (AO), the Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire de Caen, Caen, France (MOF), Service d'Anesthésie-Réanimation Chirurgicale NHC - Hôpitaux Universitaires de Strasbourg, 67094 Strasbourg cedex, France (PMM), AP-HP, 26930, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013, Paris, Île-de-France, France (DE), the Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire, Dijon, France (BB), the Département d'Anesthésie, Réanimation et Médecine Périopératoire, Groupe Hospitalier Universitaire Cochin, Paris, France (AG), AP-HP Nord, the Département d'Anesthésie Réanimation, CHU Bichat-Claude-Bernard, Paris, France. Université Paris-Cité, France (PM), the Laboratoire d'immunologie et EA7426, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France (GM), the Département d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France (ACL), Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Unité de Biostatistiques, Clermont-Ferrand, France (BP)
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Erfanipour M, Dooki ME, Nikbakht HA, Nesheli HM, Pornasrolah M, Nikpour M, Mehrabani S. Diagnostic value of neutrophil to lymphocyte ratio in identifying gastritis in children with chronic abdominal pain in northern Iran. BMC Res Notes 2025; 18:68. [PMID: 39955609 PMCID: PMC11830187 DOI: 10.1186/s13104-025-07148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 02/10/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND This study aimed to assess the diagnostic value of the Neutrophil to Lymphocyte Ratio (NLR) specifically for children with suspected gastritis. METHODS This cross-sectional study included children with chronic abdominal pain referred to Amirkola Children's Hospital, Babol, Iran, in 2021. Gastritis was diagnosed using upper gastrointestinal endoscopy and biopsy, Giemsa staining performed for Helicobacter pylori. Blood samples were analyzed to determine the NLR. Analysis was employed to establish the optimal NLR cut-off for diagnosing gastritis, with sensitivity, specificity, and predictive values calculated. RESULTS 126 patients with an average age of 10.03 ± 2.46 were included in this study. 53.2% of children were boys The overall sensitivity and specificity of the mean NLR in diagnosing gastritis in children with abdominal pain based on endoscopy were 11.76% and 97.56%, respectively and for pathology 78.57% and 11.90%, respectively (Area under curve = 0.524 for endoscopy and 0.509 for pathology). CONCLUSION This study indicate that the NLR lacks sufficient diagnostic accuracy to serve as a reliable alternative to conventional methods, such as endoscopy and pathology, for diagnosing gastritis or H. Pylori in children with chronic abdominal pain. Standard diagnostic techniques are needed for accurate evaluation and management of Helicobacter pylori-associated gastritis.
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Affiliation(s)
- Mahbubeh Erfanipour
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammadreza Esmaeili Dooki
- Pediatric Gastroenterology, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran
| | - Hossein-Ali Nikbakht
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran
| | - Hassan Mahmoodi Nesheli
- Pediatric Hematology & Oncology, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical, Babol, IR, Iran
| | - Mohammad Pornasrolah
- Clinical Research Development Unit of Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, IR, Iran
| | - Maryam Nikpour
- PhD of Health Science, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran
| | - Sanaz Mehrabani
- Pediatric Gastroenterology, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran.
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Karlidag T, Bingol O, Sarikaya B, Keskin OH, Durgal A, Ozdemir G. Prognostic accuracy of blood cell count ratios in predicting adverse outcomes in crush syndrome patients. Sci Rep 2024; 14:30494. [PMID: 39681595 DOI: 10.1038/s41598-024-82035-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 12/02/2024] [Indexed: 12/18/2024] Open
Abstract
The rationale behind this study was the lack of an accurate predictor to facilitate treatment management and anticipate prognosis in crush syndrome. Our research aimed to investigate the following: (1) Is there a correlation between the ratios of blood cell counts upon admission and the adverse outcomes of crush syndrome? and (2) if such a correlation exists, what are the precise thresholds of blood cell count ratios for predicting these adverse outcomes? In this single-centered and retrospective design study, we analyzed all patients admitted to our hospital after Kahramanmaras Earthquake. The data on length of stay in the ICU and mortality status were obtained using our hospital system. Ratios of blood cell count were calculated and recorded at the time of admission. The NLR values in admission were significantly higher in patients with amputation, patients who received intensive care unit (ICU), and patients who died. (p < 0.001, p < 0.001 and p = 0.001, respectively). The MLR values were significantly increased in patients who underwent amputation and patients who received ICU (p < 0.001 and p = 0.003, respectively). NAR values in admission were significantly higher in patients with amputation, patients who received intensive care unit (ICU), and patients who died (p < 0.001, p < 0.001, and p = 0.002, respectively). In addition, according to binary logistic regression analysis, with a CLR value of > 109.844, the risk of amputation increases 8.188 fold; with a CLR value of > 64.518, the possibility of ICU admission requirement increases 10.117 fold, and with a CLR value of > 116.00, the risk of death increases 5.519 fold. Ratios of blood cell count such as NLR, MLR, NAR, and CLR offer a reasonable prognostic accuracy in predicting adverse outcomes and mortality in patients with crush syndrome. Therefore, for better disaster management in the future, the determination of these values at admission should be used as an adjunct tool for predicting prognosis in patients with crush syndrome.
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Affiliation(s)
- Taner Karlidag
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
- Department of Orthopaedic Surgery, Gaziantep City Hospital, Gaziantep, Turkey.
| | - Olgun Bingol
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Baran Sarikaya
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Omer Halit Keskin
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Atahan Durgal
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Guzelali Ozdemir
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
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Fukuzawa S, Yamagata K, Takasaki R, Uchida F, Ishibashi-Kanno N, Bukawa H. The effectiveness of onodera`s prognostic nutritional in predicting the prognosis of tongue squamous cell carcinoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102201. [PMID: 39675525 DOI: 10.1016/j.jormas.2024.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 12/17/2024]
Abstract
PURPOSE To clarify the effects of preoperative nutritional evaluation on the prognosis of patients with tongue squamous cell carcinoma. METHODS This retrospective cohort study involves 126 consecutive patients who underwent radical surgery as their initial treatment and received treatment for >3 years. The markers considered in this study are GGT (γ-GTP), CAR (C-reactive protein (CRP)-to-Alb Ratio), GLR (GGT-to-Lymphocytes Ratio), GPR (GGT-to-Platelet ratio), GNR (GGT-to-Neutrophil ratio), NLR (Neutrophil-to-Lymphocyte ratio), PLR (platelet-to-lymphocytes ratio), OPNI (Onodera`s prognostic nutritional index), PINI (Prognostic Immune and Nutritional Index) and Albumin (Alb). Each marker was calculated from blood test results up to one month before the initial surgery to assess overall survival (OS) and disease-free survival (DFS). RESULTS Univariate analysis of OS identified the depth of invasion (DOI P = 0.004), stage classification (P < 0.001), Body mass index (BMI) (P = 0.007), OPNI (P = 0.005), prognostic inflammatory and nutritional indices (PINI, P = 0.011), and albumin (Alb) (P = 0.006) as significant predictors. Cox regression analysis revealed significant differences in BMI, pathological grade, and OPNI. The OPNI cut-off value was 51.05, indicating its effectiveness in predicting tongue cancer prognosis. With regard to DFS, only BMI showed a significant difference, with no notable difference among other markers. CONCLUSION The OPNI may be a useful prognostic factor for tongue cancer.
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Affiliation(s)
- Satoshi Fukuzawa
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
| | - Kenji Yamagata
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Ryo Takasaki
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Fumihiko Uchida
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Naomi Ishibashi-Kanno
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroki Bukawa
- Oral and Maxillofacial Surgery, Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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Shevchenko I, Grigorescu CC, Serban D, Cristea BM, Simion L, Gherghiceanu F, Costea AC, Dumitrescu D, Alius C, Tudor C, Onisai M, Gradinaru S, Dascalu AM. The Value of Systemic Inflammatory Indices for Predicting Early Postoperative Complications in Colorectal Cancer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1481. [PMID: 39336522 PMCID: PMC11434509 DOI: 10.3390/medicina60091481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/07/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Systemic inflammatory indices have been largely investigated for their potential predictive value in multiple inflammatory, infectious, and oncological diseases; however, their value in colorectal cancer is still a subject of research. This study investigates the dynamics of pre- and postoperative values of NLR, PLR, SII, and MLR in patients with colorectal cancer and their predictive value for early postoperative outcomes. Materials and Methods: A 2-year retrospective cohort study was performed on 200 patients operated for colorectal adenocarcinoma. Systemic inflammatory indices were calculated based on complete blood count preoperatively and on the first and sixth postoperative days. The patients were divided into two groups based on their emergency or elective presentation. The pre- and postoperative values of serum inflammatory biomarkers and their correlations with postoperative outcomes were separately analyzed for the two study subgroups. Results: There were no significant differences in sex distribution, addressability, associated comorbidities, or types of surgery between the two groups. Patients in the emergency group presented higher preoperative and postoperative values of WBC, neutrophils, NLR, and SII compared to elective patients. The postsurgery hospital stays correlated well with pre- and postoperative day one and day six values of NLR (p = 0.001; 0.02; and <0.001), PLR (p < 0.001), SII (p = 0.037; <0.001; <0.001), and MLR (p = 0.002; p = 0.002; <0.001). In a multivariate analysis, reintervention risk was higher for emergency presentation and anemia, and lower in right colon cancer. In the emergency group, a multivariate model including age, MLR PO1, and pTNM stage was predictive for severe postoperative complications (AUC ROC 0.818). First-day postoperative inflammatory indices correlated well with sepsis, with the best predictive value being observed for the first postoperative day NLR (AUC 0.836; sensibility 88.8%; specificity 66.7%) and SII (AUC 0.796; sensitivity 66.6%; specificity 90%). For elective patients, the first postoperative day PLR and anemia were included in a multivariate model to predict Clavien-Dindo complications graded 3 or more (AUC ROC 0.818) and reintervention (AUC ROC 0.796). Conclusions: Easy-to-calculate and inexpensive systemic inflammatory biomarkers could be useful in predicting early postoperative outcomes in colorectal cancer for both elective and emergency surgery.
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Affiliation(s)
- Irina Shevchenko
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | | | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
| | - Laurentiu Simion
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Department of Surgical Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Florentina Gherghiceanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
| | | | - Dan Dumitrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Minodora Onisai
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
- Hematology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Sebastian Gradinaru
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania; (C.C.G.); (S.G.)
- Department of General Surgery, Ilfov County Emergency Clinical Hospital, 022104 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (I.S.); (L.S.); (F.G.); (D.D.); (C.A.); (C.T.); (M.O.); (A.M.D.)
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Ioannidis A, Tzikos G, Smprini A, Menni AE, Shrewsbury A, Stavrou G, Paramythiotis D, Michalopoulos A, Kotzampassi K. Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients-The Case of Neutrophil-to-Lymphocyte Ratio. Diagnostics (Basel) 2024; 14:1806. [PMID: 39202294 PMCID: PMC11353382 DOI: 10.3390/diagnostics14161806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/03/2024] Open
Abstract
Colorectal surgery for cancer is associated with a high rate of surgical complications, including anastomotic leakage. The ability to predict the risk of leakage early enough seems to be of high value, since it would facilitate the design of personalized treatment and duration of hospitalization. Although different studies present the neutrophil-to-lymphocyte ratio [NLR] as having a strong predictive value, there is a discrepancy with respect to which postoperative day is the most reliable. We evaluated a series of NLR values, from the day before surgery up to the POD7, in a cohort of 245 colorectal surgery patients in order to clarify the best predictable score for the identification of the risk of anastomotic leakage. There were 28 patients with leaks. ROC curve analysis of NLR on POD1 indicates that a cut-off point ≥ 7.4 exerts a negative prediction for leakage (AUC 0.881, sensitivity 68.7%, specificity 96.4%, PPV 28.4%, and NPV of 99.3%), thus excluding 150 patients from the risk of leakage. Furthermore, the ROC curve analysis of NLR on POD4 indicates that a cut-off point ≥ 6.5 gives a positive prediction of leakage (AUC 0.698, sensitivity 82.1%, specificity 51.6%, PPV 17.6%, and NPV of 95.6%), thus indicating 52 patients as being at high risk of leakage. Finally, NLR failed to identify five leaks out of twenty-eight. These results strongly indicate the ability of NLR on POD1 to predict patients at low risk of developing a leak and then on POD4 to predict the high-risk patients. This makes our study particularly innovative, in that it enables doctors to concentrate on potential high-risk patients from POD1.
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Affiliation(s)
- Aristeidis Ioannidis
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Georgios Tzikos
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Aikaterini Smprini
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Alexandra-Eleftheria Menni
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Anne Shrewsbury
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - George Stavrou
- Department of Colorectal Surgery, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK;
| | - Daniel Paramythiotis
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Antonios Michalopoulos
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (A.I.); (G.T.); (A.S.); (A.-E.M.); (A.S.)
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9
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Martinez-Mier G, Carbajal-Hernández R, López-García M, Vázquez-Ramirez JA, Reyes-Ruiz JM, Solórzano-Rubio JR, González-Grajeda JL, Moreno-Ley PI. Neutrophil-to-lymphocyte ratio may predict complications and patency in bile duct injury repair. ANZ J Surg 2024; 94:1266-1272. [PMID: 39057838 DOI: 10.1111/ans.19104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Bile duct injury (BDI) repair surgery is usually associated with morbidity/mortality. The neutrophil-to-lymphocyte ratio (NLR) easily assesses a patient's inflammatory status. The study aims to determine the possible relationship between preoperative NLR (pNLR) with postoperative outcomes in BDI repair surgery. METHODS Approved Ethics/Research Committee retrospective study, in patients who had a Bismuth-Strasberg type E BDI repair (2008-2023). Data registered was: morbidity, mortality, and long-term outcomes (primary patency and loss of primary patency) (Kaplan-Meier). Group comparison (U Mann-Whitney), receiver operator characteristic (ROC): area under curve [AUC]; cut-off value, and Youden index [J], and logistic regression analysis were used for pNLR evaluation. RESULTS Seventy-three patients were studied. Mean age was 44.4 years. E2 was the commonest BDI (38.4%). Perioperative morbidity/mortality was 31.5% and 1.4%. Primary patency was 95.9%. 8.2% have lost primary patency (3-year actuarial patency: 85.3%). Median pNLR was higher in patients who had any complication (4.84 vs. 2.89 p = 0.015), biliary complications (5.29 vs. 2.86 p = 0.01), and patients with loss of primary patency (5.22 vs. 3.1 p = 0.08). AUC's, cut-off values and (J) were: any complication (0.678, pNLR = 4.3, J = 0.38, p = 0.007), serious complication (0.667, pNLR = 4.3, J = 0.34, p = 0.04), biliary complications (0.712, pNLR = 3.64, J = 0.46, p = 0.001), and loss of primary patency (0.716, pNLR = 3.24, J = 0.52, p = 0.008). Logistic regression was significant in any complication (Exp [B]: 0.1, p = 0.002), serious complications (Exp [B]: 0.2, p = 0.03), and biliary complications (Exp [B]: 8.1, p = 0.003). CONCLUSIONS pNLR is associated with complications in BDI repair with moderate to acceptable predictive capacity. pNLR could potentially predict patency of a BDI repair.
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Affiliation(s)
- Gustavo Martinez-Mier
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
- Department of Research. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Regina Carbajal-Hernández
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Mario López-García
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Jorge A Vázquez-Ramirez
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - José M Reyes-Ruiz
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Jose R Solórzano-Rubio
- Department of Research. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - José L González-Grajeda
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
| | - Pedro I Moreno-Ley
- Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
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10
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Mohammadi A, Mohammadi M, Almasi‐Dooghaee M, Mirmosayyeb O. Neutrophil to lymphocyte ratio in Alzheimer's disease: A systematic review and meta-analysis. PLoS One 2024; 19:e0305322. [PMID: 38917167 PMCID: PMC11198755 DOI: 10.1371/journal.pone.0305322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The Neutrophil-to-Lymphocyte Ratio (NLR) is a clinical indicator of peripheral inflammation that is easily accessible. It is worth noting that the formation of amyloid-β (Aβ) plaques and neurofibrillary tangles has been linked to inflammation and immune dysregulation. The main objective of this systematic review and meta-analysis is to comprehensively evaluate the existing body of research concerning the NLR in the context of Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHOD We conducted a comprehensive online search and included studies that evaluated the NLR in 1) patients with AD or MCI and 2) healthy control (HC) participants. We also pooled mean and standard deviation (SD) data for each group. RESULTS Ultimately, 12 studies encompassed 1,309 individuals diagnosed with AD with mean NLR levels of 2.68, 1,929 individuals with MCI with mean NLR levels of 2.42, and 2,064 HC with mean NLR levels of 2.06 were included in this systematic review and meta-analysis. The mean NLR was 0.59 higher in AD patients compared to HC participants (mean difference (MD) = 0.59 [0.38; 0.80]). Similarly, the mean NLR was higher in AD than MCI patients (MD = 0.23 [0.13; 0.33]). Additionally, the mean NLR was higher in individuals with MCI compared to HC participants (MD = 0.37 [0.22; 0.52]). In the subgroup meta-analysis based on the Mini-Mental State Examination (MMSE), AD patients with lower MMSE scores (using a cut-off of 20) exhibited significantly higher mean NLR (3.10 vs. 2.70, with a p-value for subgroup differences < 0.01). CONCLUSION The NLR, which serves as a marker of peripheral inflammation, shows increased levels in individuals with AD and MCI compared to HC participants. Furthermore, our study indicates that NLR levels are significantly higher in AD than MCI. Additionally, our novel finding suggests significantly higher NLR levels among AD patients with more severe cognitive decline compared to AD patients with less severe cognitive decline. So, it can be concluded that the higher cognitive decline in humans is accompanied by higher NLR levels. Further longitudinal researches are needed to explore more details about the relationship between inflammation and dementia.
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Affiliation(s)
- Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Almasi‐Dooghaee
- Neurology Department, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kocatepe G, Kaya MA, Bingol A, Uygun DFK. Is It Possible to Use Inflammatory Markers as Potential Biomarkers for Chronic Urticaria? PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:47-50. [PMID: 38864763 DOI: 10.1089/ped.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Background: This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) at admission affect the transition of pediatric patients diagnosed with acute spontaneous urticaria to chronic urticaria. Methods: This study included 390 patients who presented to the Department of Pediatrics at Akdeniz University Hospital with acute spontaneous urticaria between January 2020 and December 2022. A statistical comparison was made between the hematological parameters of patients who developed chronic urticaria and those who did not. Neutrophil, lymphocyte, and platelet counts, as well as NLR, PLR, and SII ratios, were used for the comparison. Results: It was observed that acute urticaria progressed to chronic urticaria in 5.8% (n = 23) of the patients. No significant differences in lymphocyte, hemoglobin, and platelet counts were observed between the group progressing to chronic urticaria and the control group (P > 0.05). However, the chronic urticaria group had higher leukocyte and absolute neutrophil counts (P = 0.009 and P < 0.001, respectively). In addition, the NLR was significantly higher in the chronic urticaria group (P = 0.029), whereas no statistically significant difference was observed in the PLR (P = 0.180). The chronic urticaria group had a significantly higher SII than the control group (P = 0.011). Conclusion: Hematological parameters, particularly NLR and SII, may be useful indicators of the transition from acute to chronic urticaria in pediatric patients. The early identification of these markers could help monitor patients and guide treatment decisions. Further comprehensive studies are required to validate these findings.
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Affiliation(s)
- Gaye Kocatepe
- Pediatric Allergy-Immunology Department, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mehmet Akif Kaya
- Pediatric Allergy-Immunology Department, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aysen Bingol
- Pediatric Allergy-Immunology Department, Akdeniz University School of Medicine, Antalya, Turkey
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12
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Samuels AN, Kamr AM, Reed SM, Slovis NM, Hostnik LD, Burns TA, Toribio RE. Association of the neutrophil-lymphocyte ratio with outcome in sick hospitalized neonatal foals. J Vet Intern Med 2024; 38:1196-1206. [PMID: 38284437 PMCID: PMC10937482 DOI: 10.1111/jvim.16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) in human medicine is an objective biomarker that reflects prognosis. The NLR as an independent biomarker to help predict nonsurvival in hospitalized neonatal foals has not been thoroughly interrogated. OBJECTIVES/HYPOTHESIS Retrospectively evaluate if the NLR at admission is associated with nonsurvival in sick hospitalized foals <4 days old. We hypothesized that a lower NLR will be associated with nonsurvival. ANIMALS One thousand one hundred ninety-six client-owned foals <4 days old of any breed and sex: 993 hospitalized foals and 203 healthy foals. METHODS Retrospective multicenter study. Medical records of foals presenting to 3 equine referral hospitals were reviewed. Foals were included if they had complete CBCs, sepsis scores, and outcome data. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Data were analyzed by nonparametric methods and univariate analysis. RESULTS Of the 993 sick hospitalized foals, 686 were sick nonseptic and 307 were septic. The median NLR was lower in sick hospitalized foals (median [95% confidence interval], 3.55 [0.5-13.9]) compared with healthy foals (6.61 [3.06-18.1]). Septic foals had the lowest NLR (2.00 [0.20-9.71]). The NLR was lower in nonsurviving (1.97 [1.67-2.45]) compared with surviving foals (4.10 [3.76-4.33]). Nonsurviving septic foals had the lowest NLR (1.47 [1.70-3.01]). Foals with a NLR of <3.06 or <1.6 at admission had odds ratio of 3.21 (2.24-4.29) and 4.03 (2.86-5.67) for nonsurvival, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE A NLR < 3.06 at admission in sick hospitalized foals is readily available and clinically useful variable to provide prognostic information.
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Affiliation(s)
- Amanda N. Samuels
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ahmed M. Kamr
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Laura D. Hostnik
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Teresa A. Burns
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ramiro E. Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
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13
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Philip Sridhar R, Raghunath R, Ranjan Jesudason M, Mittal R. A Three-Year Retrospective Analysis: Do Nutritional and Immunological Indices Predict Postoperative Complications After Rectal Resection? Cureus 2024; 16:e55700. [PMID: 38586728 PMCID: PMC10998259 DOI: 10.7759/cureus.55700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background Nutritional and immunological indices, such as prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been used as predictors of outcomes and survival in a few cancers. However, the literature is unclear about their usefulness in predicting postoperative complications in rectal cancer resection operations. Additionally, the prescribed cut-off values as well as the timing of the tests for these indices vary among studies. We aimed to determine the role of PNI, NLR, and PLR in predicting postoperative complications in patients undergoing rectal resection. Methods This is a retrospective analysis from a colorectal unit of a tertiary care teaching hospital. All consecutive patients undergoing rectal resection for rectal cancer between April 2018 and March 2021 were included. PNI, NLR, and PLR were calculated from preoperative blood tests, and all morbidity and mortality within 30 days of operation were considered. Results A total of 202 patients were included. Three patients who did not have the necessary preoperative blood test reports were excluded. Of the remaining 199, 142 (71.4 %) were males. The mean age was 47.3 years. Of the patients, 13.6% (n = 27) had major morbidity (Clavien-Dindo grade 3-5), including one mortality. The mean PNI, NLR, and PLR were 49.9, 4.3, and 230.5, respectively. The mean PNI between the groups (no complication vs. complication) was 49.6 vs. 50.1 (p = 0.46) and the mean NLR between the same groups was 4.7 vs. 3.8, (p = 0.06), and both were not significant. The mean PLR between the groups (256.3 vs. 203.4, p = 0.01) was found to be significant but significance was not elicited when only major complications were considered. Hence, none of the indices were a good predictor of postoperative complications in our study. Conclusion The role of nutritional and immunological indices (PNI, NLR, and PLR) is limited in predicting postoperative morbidity in rectal resection operations.
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Affiliation(s)
| | - Rajat Raghunath
- General and Colorectal Surgery, Christian Medical College and Hospital, Vellore, IND
| | - Mark Ranjan Jesudason
- General and Colorectal Surgery, Christian Medical College and Hospital, Vellore, IND
| | - Rohin Mittal
- General and Colorectal Surgery, Christian Medical College and Hospital, Vellore, IND
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Wang CY, Li XL, Ma XL, Yang XF, Liu YY, Yu YJ. Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis. World J Gastrointest Surg 2024; 16:438-450. [PMID: 38463372 PMCID: PMC10921198 DOI: 10.4240/wjgs.v16.i2.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR), a composite inflammatory biomarker, is associated with the prognosis in patients with colorectal tumors. However, whether the NLR can be used as a predictor of symptomatic postoperative anastomotic leakage (AL) in elderly patients with colon cancer is unclear. AIM To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon cancer. METHODS Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively analyzed. Receiver operating characteristic curve analysis was performed to determine the best predictive cutoff value for the NLR. Twenty-two covariates were matched using a 1:1 propensity score matching method, and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative AL. RESULTS Of the 577 patients included, 36 (6.2%) had symptomatic AL. The optimal cutoff value of the NLR for predicting AL was 2.66. After propensity score matching, the incidence of AL was significantly greater in the ≥ 2.66 NLR subgroup than in the < 2.66 NLR subgroup (11.5% vs 2.5%; P = 0.012). Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoperatively, preoperative albumin concentration, preoperative prognostic nutritional index, and preoperative NLR and AL occurrence (P < 0.05); multivariate logistic regression analysis revealed that an NLR ≥ 2.66 [odds ratio (OR) = 5.51; 95% confidence interval (CI): 1.50-20.26; P = 0.010] and blood transfusion intraoperatively and within 2 d postoperatively (OR = 2.52; 95%CI: 0.88-7.25; P = 0.049) were risk factors for the occurrence of symptomatic AL. CONCLUSION A preoperative NLR ≥ 2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly patients with colon cancer. The preoperative NLR has predictive value for postoperative symptomatic AL after elective surgery in elderly patients with colon cancer.
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Affiliation(s)
- Chao-Yang Wang
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Long Li
- Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Long Ma
- Department of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Xiong-Fei Yang
- Department of Anorectology, Gansu Provincial People’s Hospital, Lanzhou 730000, Gansu Province, China
| | - Yong-Yong Liu
- Department of General Surgery, The Second Hospital Affiliated to Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yong-Jiang Yu
- Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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de Fréminville A, Saad M, Sage E, Pricopi C, Fischler M, Trillat B, Salze B, Pascreau T, Vasse M, Vallée A, Guen ML, Fessler J. Relationship Between Preoperative Inflammation Ratios Derived From Preoperative Blood Cell Count and Postoperative Pulmonary Complications in Patients Undergoing Lobectomy: A Single-Center Observational Study. J Cardiothorac Vasc Anesth 2024; 38:482-489. [PMID: 38016820 DOI: 10.1053/j.jvca.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Evaluation of the association of inflammatory cell ratios, especially neutrophil-to-lymphocyte ratio (NLR), based on preoperative complete blood counts, with postoperative complications in lobectomy surgery. DESIGN This was a retrospective monocentric cohort study. SETTING The study was conducted at Foch University Hospital in Suresnes, France. PARTICIPANTS Patients having undergone a scheduled lobectomy from January 2018 to September 2021. INTERVENTIONS There were no interventions. MEASUREMENTS AND MAIN RESULTS The authors studied 208 consecutive patients. Preoperative NLR, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation index, systemic inflammation response index, and aggregate inflammation systemic index were calculated. Median and (IQR) of NLR was 2.67 (1.92-3.69). No statistically significant association was observed between any index and the occurrence of at least one major postoperative complication, which occurred in 37% of the patients. Median postoperative length of stay was 7 (5-10) days. None of the ratios was associated with prolonged length of stay (LOS), defined as a LOS above the 75th percentile. CONCLUSIONS The results suggested that simple available inflammatory ratios are not useful for the preoperative identification of patients at risk of postoperative major complications in elective lobectomy surgery.
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Affiliation(s)
- Amaury de Fréminville
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Mary Saad
- Department of Anesthesia, Institut Curie, PSL Research University, Saint Cloud, France, and PSL Research University, INSERM, Institut Curies, Saint Cloud, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Ciprian Pricopi
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
| | - Bernard Trillat
- Department of Information Systems, Hôpital Foch, Suresnes, France
| | - Benjamin Salze
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Tiffany Pascreau
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Delgado-Miguel C, Miguel-Ferrero M, García A, Delgado B, Camps J, Martínez L. Neutrophil-to-lymphocyte ratio as a predictor of postoperative complications and readmissions after appendectomy in children. Updates Surg 2023; 75:2273-2278. [PMID: 37659982 DOI: 10.1007/s13304-023-01639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
To analyze the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the development of postoperative complications and readmission after appendectomy in children. A retrospective single-centered case-control study was conducted on children who underwent appendectomy between 2017 and 2020. Demographics, time since symptoms onset, laboratory tests at admission, postoperative complications, and readmissions in the first 30 days after surgery were recorded. Sensitivity and specificity analysis of the parameters evaluated were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. A total of 1,214 patients (765 males; 449 females) were included, with a median age at diagnosis of 10.4 years. The median time from symptom onset was 24 h. During the first 30 days after surgery, 149 postoperative complications were reported (12.3%). NLR at admission presented the highest AUC (0.753), with a cut-off point of 10.5 for maximum sensitivity (68.7%) and specificity (86.1%). Readmissions were reported in 45 cases (3.7%). NLR at admission presented an AUC of 0.794 significantly higher than neutrophils (0.696), leukocytes (0.654), and time since symptom onset (0.622), making these differences statistically significant (p < 0.001). The cut-off point of NLR > 12.4 was estimated, with a maximum sensitivity and specificity of 71.0% and 82.3% for predicting readmission. NLR is an independent predictor of postoperative complications and readmission in children with acute appendicitis. While its application in routine clinical practice has yet to be established, the NLR may provide clinicians with a tool for identifying high-risk surgical patients.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA.
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain.
| | | | - Antonella García
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
| | - Bonifacio Delgado
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
- Institute for Biomedical Research La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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17
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Guest JD, Luo Z, Liu Y, Gao H, Wang D, Xu XM, Zhu H. Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report. Neural Regen Res 2023; 18:2781-2784. [PMID: 37449645 DOI: 10.4103/1673-5374.373668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Rarely, penetrating injuries to the spinal cord result from wooden objects, creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions. We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick. While initially tetraparetic, he rapidly recovered function. The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord. A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation. On the 7th day after injury, fever and paresthesias occurred with a large increase in serum inflammatory indicators, and the patient agreed to undergo surgical removal of the wooden object. We discuss the management nuances related to wood, the longitudinal evolution of MRI findings, infection risk, surgical risk mitigation and technique, an inflammatory marker profile, long-term recovery, and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries. The patient had an excellent clinical outcome. The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection, and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.
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Affiliation(s)
- James D Guest
- Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Zhuojing Luo
- Department of Orthopedic Spinal Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yansheng Liu
- Department of Neurosurgery, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Hongkun Gao
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Dianchun Wang
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
| | - Xiao-Ming Xu
- Indiana University School of Medicine, Stark Neurosciences Research Institute, Indianapolis, IN, USA
| | - Hui Zhu
- Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China
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18
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Kato H, Seishima R, Nakamura K, Matsui S, Shigeta K, Okabayashi K, Kitagawa Y. The Prognostic Nutritional Index is a Predictive Marker for Postoperative Complications in Patients with Late-Onset Ulcerative Colitis. World J Surg 2023; 47:2867-2875. [PMID: 37470793 DOI: 10.1007/s00268-023-07118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The number of patients with late-onset ulcerative colitis (UC) requiring surgery has increased in recent years. The risk of postoperative complications is higher in the elderly, so preoperative assessment is important. We aimed to explore the performance of preoperative assessment of nutritional markers for predicting postoperative complications in patients with late-onset UC. METHODS We retrospectively analysed 140 medically refractory UC patients who underwent surgery. The association between age at UC onset and risk of postoperative complications was explored using a fractional polynomial model. Uni- and multi-variate logistic regression analyses were performed to identify nutritional markers associated with postoperative complications. RESULTS The polynomial model showed patients with UC onset after 50 years of age had an increased risk of postoperative complications. Late-onset (LO) UC, an onset occurring after 50 years old, was associated with a higher risk of incisional surgical site infection (SSI) and intra-abdominal abscess than early-onset (EO) UC. Compared with the EO group, the LO group had fewer nutritional markers that were significantly associated with postoperative complications. The prognostic nutritional index (PNI) was calculated using the albumin level and the total lymphocyte count, and it was the only index that was significant in the LO group (odds ratio 0.872 95% CI 0.77-0.99, P = 0.03). CONCLUSIONS It was more difficult to use nutritional status to predict the risk of postoperative complications in patients with late-onset UC than in patients with early-onset ulcerative colitis. PNI may be a useful nutritional marker for patients with both late- and early-onset UC.
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Affiliation(s)
- Hirochika Kato
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryo Seishima
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kimihiko Nakamura
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shimpei Matsui
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kohei Shigeta
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koji Okabayashi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi , Shinjuku-ku, Tokyo, 160-8582, Japan
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19
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Oka T, Kouda K, Okada N, Saisyo A, Kashibe K, Hirano Y, Hiraki S, Yamasaki H, Ishida H, Kitahara T. A low prognostic nutritional index is associated with increased remote infections within 30 days of colorectal surgery: A retrospective cohort study. Am J Infect Control 2023; 51:1218-1224. [PMID: 37075854 DOI: 10.1016/j.ajic.2023.04.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE This study aimed to identify risk factors for remote infection (RI) within 30 days after colorectal surgery. METHODS This retrospective study included 660 patients who underwent colorectal surgery at Yamaguchi University Hospital or Ube Kosan Central Hospital between April 2015 and March 2019. Using electronic medical records, we identified the incidence of surgical site infection and RI within 30 days after surgery and obtained information on associated factors. Univariate and multivariable analyses were performed to identify significant risk factors in 607 (median age, 71 years) patients. RESULTS Seventy-eight (13%) and 38 (6.3%) patients had surgical site infection and RI, respectively. Of the 38 patients diagnosed with RI, 14 (36.8%) had a bloodstream infection, 13 (34.2%) had a urinary tract infection, 8 (21.1%) had a Clostridioides difficile infection, and 7 (18.4%) had respiratory tract infections. Multivariable analysis showed that a preoperative prognostic nutritional index of ≤40 (OR, 2.30; 95% CI, 1.07-4.92; P = .032), intraoperative blood transfusion (OR (odds ratio), 3.06; 95% CI, 1.25-7.47; P = .014), and concomitant stoma creation (OR, 4.13; 95% CI, 1.93-8.83; P = .0002) were significant RI predictors. CONCLUSIONS Nutritional interventions prompted by low preoperative prognostic nutritional index in colorectal surgery may lead to decreases in postoperative RI.
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Affiliation(s)
- Tomoyuki Oka
- Pharmacy Department, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan; Clinical Pharmacology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kyoji Kouda
- Pharmacy Department, Hofu Institute of Gastroenterology, Hofu, Yamaguchi, Japan
| | - Naoto Okada
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Atsuyuki Saisyo
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Kouichi Kashibe
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yasushi Hirano
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Sakurao Hiraki
- Department of Surgery, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan
| | - Hirofumi Yamasaki
- Pharmacy Department, Ube-Kohsan Central Hospital, Ube, Yamaguchi, Japan
| | - Haku Ishida
- Medical Informatics and Decision Sciences, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Takashi Kitahara
- Pharmacy Department, Yamaguchi University Hospital, Ube, Yamaguchi, Japan; Clinical Pharmacology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
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20
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Yang N, Yang K, Pan S, He Q, Jin J. Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications. Ren Fail 2023; 45:2259996. [PMID: 37791567 PMCID: PMC10552595 DOI: 10.1080/0886022x.2023.2259996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a novel predictive biomarker that reflects systemic inflammatory status and is routinely measured in blood tests. Owing to its ease of use and affordability, it is being increasing used as a prognostic indicator of cardiovascular disease, tumors, autoimmune disorders, and kidney disease. In recent years, a number of studies have demonstrated the clinical utility of the NLR in identifying and predicting complications associated with hemodialysis and peritoneal dialysis, including cardiovascular disease and infection. This review aimed to provide a new perspective on the application of the NLR as a valuable tool enabling clinicians to better assess the occurrence and prognosis of complications in patients undergoing dialysis.
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Affiliation(s)
- Nan Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Kaibi Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Shujun Pan
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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21
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Kao DD, Ferrandino RM, Roof SA, Marshall DC, Khan MN, Chai RL, Park YHA, Sigel KM. Neutrophil-to-lymphocyte ratio as a predictor of surgical outcomes in head and neck cancer. Head Neck 2023; 45:1903-1912. [PMID: 37204760 PMCID: PMC10349925 DOI: 10.1002/hed.27402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/17/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation that is associated with adverse oncologic and surgical outcomes. We investigated the use of NLR as a prognostic indicator of complications of head and neck cancer (HNC) surgeries. METHODS We conducted a retrospective study of 11 187 Veterans who underwent HNC surgery between 2000 and 2020. We calculated preoperative NLR values and fit logistic regression models adjusting for potential confounding factors, comparing high-NLR patients to low-NLR patients. RESULTS The cohort had a median age of 63 and was 98% men. High-NLR patients had increased odds of 30-day mortality (p < 0.001), having 1+ perioperative complications (p < 0.001), sepsis (p = 0.03), failure to wean from mechanical ventilation (p = 0.04), pneumonia (p < 0.001), and pulmonary embolism (p = 0.02) compared with low-NLR patients. CONCLUSION NLR was a robust, independent predictor of 30-day mortality, having 1+ surgical complications, sepsis, failure to wean from mechanical ventilation, pneumonia, and pulmonary embolism.
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Affiliation(s)
- Derek D. Kao
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rocco M. Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott A. Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah C. Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raymond L. Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeun-Hee A. Park
- Department of Medicine, Division of Hematology/Oncology, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine, Division of Hematology/Oncology, The College of Physicians and Surgeons at Columbia University, New York, New York, USA
| | - Keith M. Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Glisic T, Popovic DD, Lolic I, Toplicanin A, Jankovic K, Dragasevic S, Aleksic M, Stjepanovic M, Oluic B, Matovic Zaric V, Radisavljevic MM, Stojkovic Lalosevic M. Hematological Indices Are Useful in Predicting Complications of Liver Cirrhosis. J Clin Med 2023; 12:4820. [PMID: 37510935 PMCID: PMC10381513 DOI: 10.3390/jcm12144820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Liver cirrhosis is the final stage of chronic liver disease. We aimed to evaluate non-invasive scores as predictors of complications and outcome in cirrhotic patients. METHODS A total of 150 cirrhotic patients were included. Models for end-stage liver disease (MELD), albumin-bilirubin (ALBI) score, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MoLR), and neutrophil-lymphocyte-albumin ratio (NLA) scores were tested in relation to the development of complications and mortality using receiver operating characteristic (ROC) curves. RESULTS The ROC curve analysis showed (area under the curve) AUC values of NLR, NLA, ALBI, and MELD of 0.711, 0.730, 0.627, and 0.684, respectively, for short-term mortality. MELD, ALBI, and NLA scores showed a statistically significant correlation with hepatic encephalopathy (p = 0.000 vs. 0.014 vs. 0.040, respectively), and the MELD cut-off value of 16 had a sensitivity of 70% and a specificity of 52% (AUC: 0.671, 95% CI (0.577-0.765)). For the assessment of the presence of ascites, the AUC values for NLA and MoLR were 0.583 and 0.658, respectively, with cut-offs of 11.38 and 0.44. CONCLUSIONS MELD, ALBI, and NLA are reliable predictors of hepatic encephalopathy. NLA and MoLR showed a significant correlation with the presence of ascites, and MELD, ALBI, NLR, and NLA have prognostic value to predict 30-day mortality in cirrhotic patients.
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Affiliation(s)
- Tijana Glisic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
| | - Dusan D. Popovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia
| | - Iva Lolic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
| | - Aleksandar Toplicanin
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
| | - Katarina Jankovic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
| | - Sanja Dragasevic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
| | - Marko Aleksic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
| | - Mihailo Stjepanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
| | - Branislav Oluic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
| | - Vera Matovic Zaric
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
| | | | - Milica Stojkovic Lalosevic
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.L.); (A.T.); (K.J.); (S.D.); (V.M.Z.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.P.); (M.A.); (M.S.); (B.O.)
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Pergialiotis V, Papalios T, Haidopoulos D, Papapanagiotou A, Vlachos A, Rodolakis A, Thomakos N. Pre-Operative Neutrophil-to-Lymphocyte Ratio as a Predictor of Post-Operative Infectious Morbidity in Gynecologic Oncology Patients. Surg Infect (Larchmt) 2023; 24:390-396. [PMID: 37040268 DOI: 10.1089/sur.2022.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR) has been described as a predictor of progression-free and overall survival, and in the field of peri-operative care it seems to be a factor that can help discriminate patients at risk of developing post-operative complications. In the present study we sought to determine whether NLR is useful as a biomarker in predictive models that aim to identify patients with gynecologic cancer undergoing surgery at risk of developing post-operative infectious morbidity. Patients and Methods: We designed a prospective cohort study that enrolled 208 patients with gynecologic cancer. Post-operative infectious morbidity was evaluated based on a 30-day follow-up interval from the procedure. Results: Forty-three patients (20.5%) developed post-operative infectious morbidity. Using an optimal cutoff value of 1.7 for the pre-operative NLR we observed that the sensitivity of the biomarker was 76.7% and the specificity 73.3% with a produced area under the curve of 0.760 (95% confidence interval [CI], 0.680-0.839). Univariable logistic regression indicated that NLR is a predictor of post-operative morbidity. Cox regression analysis revealed that NLR was the only factor that was associated with the timing of infectious morbidity (hazard ratio [HR], 1.339; 95% CI, 1.180-1.519; p < 0.001). Using random forest analysis and decision trees we achieved a diagnostic accuracy of the predictive model that exceeded 90%. Conclusions: Neutrophil-to-lymphocyte ratio may be a factor that could potentially help evaluate the risk of post-operative morbidity in patients with gynecologic cancer.
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Affiliation(s)
- Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Theodoros Papalios
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Dimitrios Haidopoulos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, Medical School, National and Kapodistrial University of Athens, Athens, Greece
| | - Athanasios Vlachos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, "Alexandra" General Hospital, Athens, Greece
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Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 2023; 408:113. [PMID: 36859650 DOI: 10.1007/s00423-023-02851-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE The Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC. METHODS We retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling. RESULTS Severe POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257 min), blood loss (≥ 30 mL), albumin (< 4.0 g/dL), CRP (≥ 1.0 mg/dL), total cholesterol (≤ 180 mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257 min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers. CONCLUSION The NPS is a valuable predictor of severe POCs in RC.
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25
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Zhang Z, Sun W, Wang J, Deng Y, Yan Y, Li D, Fu W. A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index. Front Surg 2023; 9:1008448. [PMID: 36684195 PMCID: PMC9852538 DOI: 10.3389/fsurg.2022.1008448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background Anastomotic leakage is a serious complication after colorectal cancer surgery, which affects the quality of life and the prognosis. This study aims to create a novel nomogram to predict the risk of anastomotic leakage for patients with colorectal cancer based on the preoperative inflammatory-nutritional index and abdominal aorta calcium index. Methods 292 patients at Tianjin Medical University General Hospital (Tianjin, China) from January 2018 to October 2021 who underwent colorectal cancer surgery with a primary anastomosis were retrospectively reviewed. A nomogram was constructed based on the results of multivariate logistic regression model. The calibration curves and receiver operating characteristic curves were used to verify the efficacy of the nomogram. Results Univariate and multivariate analyses showed that tumor location (P = 0.002), preoperative albumin (P = 0.006), preoperative lymphocyte (P = 0.035), preoperative neutrophil to lymphocyte ratio (P = 0.024), and superior mesenteric artery calcium volumes score (P = 0.004) were identified as the independent risk factors for postoperative anastomotic leakage in patients with colorectal carcinoma. A nomogram was constructed based on the results of the multivariate analysis, and the C-index of the calibration curves was 0.913 (95%CI: 0.870-0.957) in the training cohort and 0.840 (95%CI: 0.753-0.927) in the validation cohort. Conclusion The nomogram, combining basic variables, inflammatory-nutritional index and abdominal aorta calcium index, could effectively predict the possibility of postoperative anastomotic leakage for patients with colorectal cancer, which could guide surgeons to carry out the appropriate treatment for the prevention of anastomotic leakage.
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Affiliation(s)
- Zhaoxiong Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Weilin Sun
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China,Department of Gastrointestinal Surgery, The People's Hospital of Qiannan, Duyun, China
| | - Yuanlin Deng
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongjia Yan
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China,Correspondence: Weihua Fu
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Lara-Morga C, Palka-Kotlowska M, Custodio-Cabello S, Pacheco-Barcia V, Cabezón-Gutiérrez L. Complete response to third-line treatment with trifluridine/tipiracil (TAS-102) in stage IV colon adenocarcinoma. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:307-315. [PMID: 37205314 PMCID: PMC10185440 DOI: 10.37349/etat.2023.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/14/2023] [Indexed: 05/21/2023] Open
Abstract
A clinical case of a 61-year-old female diagnosed with stage IV right colon adenocarcinoma (unresectable liver and multiple lymph node metastases at the time of diagnosis), Kirsten rat sarcoma viral oncogene homolog (KRAS), neuroblastoma rat sarcoma viral oncogene homolog (NRAS) and v-raf murine sarcoma viral oncogene homolog B (BRAF) wild-type, proficient mismatch repair (pMMR), in whom a complete response to the third-line of systemic treatment with trifluridine/tipiracil (TAS-102) was obtained. The complete response has been maintained for more than 2 years after its suspension.
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Affiliation(s)
- Celia Lara-Morga
- Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Magda Palka-Kotlowska
- Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
- Medical Oncology, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain
| | - Sara Custodio-Cabello
- Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
- Medical Oncology, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain
| | - Vilma Pacheco-Barcia
- Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
- Medical Oncology, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain
| | - Luis Cabezón-Gutiérrez
- Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain
- Medical Oncology, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain
- Correspondence: Luis Cabezón-Gutiérrez, Facultad de Medicina, Universidad Francisco Vitoria, 28223 Pozuelo de Alarcón, Madrid, Spain; Medical Oncology, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain.
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Patrascu S, Cotofana-Graure GM, Surlin V, Mitroi G, Serbanescu MS, Geormaneanu C, Rotaru I, Patrascu AM, Ionascu CM, Cazacu S, Strambu VDE, Petru R. Preoperative Immunocite-Derived Ratios Predict Surgical Complications Better when Artificial Neural Networks Are Used for Analysis-A Pilot Comparative Study. J Pers Med 2023; 13:101. [PMID: 36675762 PMCID: PMC9861480 DOI: 10.3390/jpm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to comparatively assess the prognostic preoperative value of the main peripheral blood components and their ratios-the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR)-to the use of artificial-neural-network analysis in determining undesired postoperative outcomes in colorectal cancer patients. Our retrospective study included 281 patients undergoing elective radical surgery for colorectal cancer in the last seven years. The preoperative values of SII, NLR, LMR, and PLR were analyzed in relation to postoperative complications, with a special emphasis on their ability to accurately predict the occurrence of anastomotic leak. A feed-forward fully connected multilayer perceptron network (MLP) was trained and tested alongside conventional statistical tools to assess the predictive value of the abovementioned blood markers in terms of sensitivity and specificity. Statistically significant differences and moderate correlation levels were observed for SII and NLR in predicting the anastomotic leak rate and degree of postoperative complications. No correlations were found between the LMR and PLR or the abovementioned outcomes. The MLP network analysis showed superior prediction value in terms of both sensitivity (0.78 ± 0.07; 0.74 ± 0.04; 0.71 ± 0.13) and specificity (0.81 ± 0.11; 0.69 ± 0.03; 0.9 ± 0.04) for all the given tasks. Preoperative SII and NLR appear to be modest prognostic factors for anastomotic leakage and overall morbidity. Using an artificial neural network offers superior prognostic results in the preoperative risk assessment for overall morbidity and anastomotic leak rate.
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Affiliation(s)
- Stefan Patrascu
- Sixth Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Valeriu Surlin
- Sixth Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - George Mitroi
- Sixth Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mircea-Sebastian Serbanescu
- Department of Medical Informatics and Statistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cristiana Geormaneanu
- Emergency Medicine Department, University of Medicine and Pharmacy of Craiova, 200342 Craiova, Romania
| | - Ionela Rotaru
- Hematology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana-Maria Patrascu
- Hematology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Sergiu Cazacu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Radu Petru
- Department of Surgery, “Carol Davila” Clinical University Hospital, 010731 Bucharest, Romania
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Ohsawa M, Hamai Y, Emi M, Ibuki Y, Kurokawa T, Yoshikawa T, Hirohata R, Kitasaki N, Okada M. Blood biomarkers as predictors of pathological lymph node metastasis in clinical stage T1N0 esophageal squamous cell carcinoma. Dis Esophagus 2022; 36:6627607. [PMID: 35780322 DOI: 10.1093/dote/doac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Indexed: 01/19/2023]
Abstract
Accurate preoperative evaluation of lymph node (LN) metastasis is important for determining the treatment strategy for superficial esophageal cancer. Blood biomarkers, such as the neutrophil-lymphocyte, platelet-lymphocyte, and lymphocyte-monocyte ratios (NLR, PLR, and LMR, respectively), have clinical applications as predictors of LN metastasis for different cancers. Here, we investigated the use of these ratios as predictors of pathological LN metastasis and prognosis in patients with clinical stage T1N0M0 esophageal squamous cell carcinoma (ESCC). Patients (n = 185) with cT1N0M0 ESCC who underwent esophagectomy with R0 resection between April 2003 and August 2021 were enrolled. We investigated the ability of pretreatment NLR, PLR, and LMR to predict pathological LN metastasis. The optimal cutoff values of NLR, PLR, and LMR to predict pathological LN metastasis were 2.1, 122, and 4.8, respectively. Univariate and multivariate analyses revealed that the primary tumor length, depth of invasion, and NLR were significant predictors of LN metastasis. Furthermore, similar to the 5-year overall survival, the 5-year relapse-free survival was significantly better in the low NLR group than in the high NLR group. The NLR was the most useful predictor of pathological LN metastasis. Patients diagnosed with clinical stage I ESCC and with a high NLR require adequate LN dissection and may be good candidates for preoperative adjuvant therapy.
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Affiliation(s)
- Manato Ohsawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Yoichi Hamai
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Manabu Emi
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Tomoaki Kurokawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Toru Yoshikawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Ryosuke Hirohata
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Nao Kitasaki
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan
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29
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Tan F, Xu K, Qi X, Gao P, Liu M, Yao Z, Zhang N, Yang H, Zhang C, Xing J, Cui M, Su X. Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Symptomatic Anastomotic Leakage in Patients after Rectal Cancer Surgery: A Propensity Score-Matched Analysis. J Pers Med 2022; 13:93. [PMID: 36675754 PMCID: PMC9862085 DOI: 10.3390/jpm13010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
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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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Rosca O, Bumbu BA, Ancusa O, Talpos S, Urechescu H, Ursoniu S, Bloanca V, Pricop M. The Role of C-Reactive Protein and Neutrophil to Lymphocyte Ratio in Predicting the Severity of Odontogenic Infections in Adult Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010020. [PMID: 36676644 PMCID: PMC9866968 DOI: 10.3390/medicina59010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Odontogenic infections (OI) represent a frequent cause of dental and maxillo-facial interventions, mostly due to late presentations or misdiagnosed complications. It is believed that the intensity of the immunoinflammatory response in OI is the main prognostic factor. Therefore, in this research, it was pursued to determine if the combination of C-reactive protein (CRP) and Neutrophil to Lymphocyte Ratio (NLR) (CRP-NLR) may serve as potential severity predictors in patients with odontogenic infections. Materials and Methods: A retrospective analysis on 108 patients hospitalized for odontogenic infections was conducted at the Department of Maxillofacial Surgery. Depending on the symptom severity scale, patients hospitalized with OI were divided into two equal groups based on infection severity (SS). Results: Patients with severe OI from Group B were associated more frequently with diabetes mellitus and smoking more often than those with a lower severity from Group A. In Group A, abscesses of odontogenic origin accounted for 70.4% of hospitalizations, while in Group B, abscesses and cellulitis were associated in 55.6% of cases (p-value < 0.001). The disease outcomes were more severe in Group B patients, where 22.2% of them developed sepsis, compared to 7.4% of Group A patients (p-value = 0.030). However, there was no significant difference in mortality rates. The SS and systemic immune inflammation index (SII) scores of Group B patients were substantially higher than Group A patients (13.6 vs. 6.1 for the SS score, p-value < 0.001), respectively, 2312.4 vs. 696.3 for the SII score (p-value < 0.001). All biomarker scores, including the CRP-NLR relationship, were considerably higher in Group B patients, with a median score of 341.4 vs. 79.0 in Group B (p-value < 0.001). The CRP-NLR association determined a 7.28-fold increased risk of severe OI. The receiver operating curve (ROC) analysis of CRP-NLR yielded an area under curve (AUC) value of 0.889, with high sensitivity (79.6%) and high specificity (85.1%), for predicting a severe odontogenic infection using biomarkers measured at hospital admission (p-value < 0.001). Conclusions: Therefore, it can be concluded that CRP-NLR is a reliable and affordable biomarker for determining the severity of odontogenic infections that may be included in other prognostic models for dental infections.
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Affiliation(s)
- Ovidiu Rosca
- Department XIII, Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bogdan Andrei Bumbu
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, University Street 1, 410087 Oradea, Romania
- Correspondence:
| | - Oana Ancusa
- Department V, Discipline of Medical Semiology I, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Serban Talpos
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Horatiu Urechescu
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Sorin Ursoniu
- Department of Functional Sciences, Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Akcaalan S, Ozaslan HI, Caglar C, Şimşek ME, Citak M, Akkaya M. Role of Biomarkers in Periprosthetic Joint Infections. Diagnostics (Basel) 2022; 12:diagnostics12122958. [PMID: 36552965 PMCID: PMC9777153 DOI: 10.3390/diagnostics12122958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most serious complications after joint arthroplasty. The incidence rate of PJI after total joint replacement is 1-3%. Although there are different guidelines and diagnostic criteria used to diagnose PJI, diagnosing PJI is a highly difficult process for orthopedists. The current Musculoskeletal Infection Society (MSIS) criteria are widely used for the diagnosis of PJI. These criteria include results from blood/synovial fluid tests, physical examination, and histological and microbiological analyses of intra-operative samples. However, there is currently no blood or synovial test that can definitively diagnose PJI. To make a more effective diagnosis of PJI, a large number of studies have explored and continue to investigate biomarkers. This review aims to provide general information about serum and synovial markers used for the diagnosis of PJI that may be used to create a database to guide researchers in new studies.
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Affiliation(s)
- Serhat Akcaalan
- Kırıkkale Yuksek Ihtısas Hospital, Kırıkkale 71300, Turkey
- Correspondence:
| | - Halil Ibrahim Ozaslan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06010, Turkey
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara 06800, Turkey
| | - Ceyhun Caglar
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara 06800, Turkey
| | - Mehmet Emin Şimşek
- Department of Orthopedics and Traumatology, Faculty of Medicine, Lokman Hekim University, Ankara 06230, Turkey
| | | | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06010, Turkey
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara 06800, Turkey
- Helios ENDO-Klinik Hamburg, 22767 Hamburg, Germany
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Xu H, Liu L, Xie J, Huang Q, Lai Y, Zhou Z. Plasma fibrinogen: a sensitive biomarker for the screening of periprosthetic joint infection in patients undergoing re-revision arthroplasty. BMC Musculoskelet Disord 2022; 23:520. [PMID: 35650619 PMCID: PMC9158301 DOI: 10.1186/s12891-022-05476-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
Background Although serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen and neutrophil–lymphocyte ratio (NLR) are promising biomarkers for screening PJI in patients undergoing revision arthroplasty, their efficacy with respect to re-revision arthroplasty remains unclear. Methods We included patients who underwent re-revision arthroplasty at our hospital during 2008–2020, and stratified them into two groups whether they had been diagnosed with PJI (infected) or aseptic failure (non-infected) according to the 2013 International Consensus Meeting criteria. We evaluated the diagnostic performance of CRP, ESR, fibrinogen and NLR, both individually and in combinations, based on sensitivity, specificity, and area under the receiver operating characteristic curve. Results Of the 63 included patients, 32 were diagnosed with PJI. The area under the ROC curve was 0.821 for CRP, 0.794 for ESR, 0.885 for fibrinogen and 0.702 for NLR. CRP gave a sensitivity of 87.5% and specificity of 74.2% with an optimal predictive cut-off of 8.50 mg/mL. ESR gave a sensitivity of 81.3% and specificity of 71.0% with an optimal predictive cut-off of 33 mm/h. Plasma fibrinogen gave a comparatively higher sensitivity of 93.8% and specificity of 77.4% with an optimal predictive cut-off of 3.55 g/L, while NLR gave a moderate sensitivity of 84.4% but low specificity of 54.8% with an optimal predictive cut-off of 2.30. The combination of fibrinogen and CRP gave a high AUC of 0.897, an acceptable sensitivity of 75% and a high specificity 93.5%. Conclusions Plasma fibrinogen is a cost-effective, convenient biomarker that can be used to rule out PJI in patients scheduled for re-revision arthroplasty. In combination with CRP, it may be effective in diagnosing PJI in such patients.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Li Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yahao Lai
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China.
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Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci 2022; 23:3636. [PMID: 35408994 PMCID: PMC8998851 DOI: 10.3390/ijms23073636] [Citation(s) in RCA: 397] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/27/2023] Open
Abstract
Over the last 10 years, the evaluation of the neutrophil-to-lymphocyte ratio (NLR) as an emerging marker of diseases has become a compelling field of bio-medical research. Although a precise and unique cut-off value has not been yet found, its role as a flag of immune system homeostasis is well established. NLR has a well-known prognostic value and independently correlates with mortality in the general population and in several specific subsets of disease (sepsis, pneumonia, COVID-19, cancer, etc.). Moreover, NLR was recently considered as part of the decision-making processes concerning the admission/recovery of patients with COVID-19 pneumonia. This review aims to provide an overview of the main use of this biomarker, focusing on the pathophysiology and the molecular basis underlying its central role as a reliable mirror of inflammatory status and adaptive immunity.
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Affiliation(s)
- Agata Buonacera
- Emergency Department, Policlinico S. Marco, 95121 Catania, Italy;
| | | | - Michele Colaci
- Academic Unit of Internal Medicine and Hypertension Centre, Department of Clinical and Experimental Medicine, University of Catania, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Lorenzo Malatino
- Academic Unit of Internal Medicine and Hypertension Centre, Department of Clinical and Experimental Medicine, University of Catania, Cannizzaro Hospital, 95126 Catania, Italy;
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Abe A, Ito Y, Hayashi H, Nakayama A, Furuta H, Momokita M, Hasegawa H, Tsunoda A. Relationship between nutritional biomarkers and occlusal status in gastric cancer patients using the Eichner index: Observational study. Medicine (Baltimore) 2022; 101:e29094. [PMID: 35356942 PMCID: PMC10684134 DOI: 10.1097/md.0000000000029094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Systemic inflammatory responses and nutritional status are useful prognostic factors in gastric cancer patients. Since oral hypofunction causes undernutrition, we cross-sectionally investigated whether nutritional biomarkers were affected by the occlusal supporting zone status.In 114 gastric cancer patients, the gastric cancer stage, body mass index, albumin levels, total lymphocyte counts, cholesterol levels, C-reactive protein levels, and 4 nutritional biomarkers - the Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio, prognostic nutrition index (PNI), and controlling nutritional status (CONUT) - were evaluated. Oral conditions were assessed by determining the number of remaining teeth. The occlusal supporting status was based on the Eichner classification. Patients were assigned into 3 groups per their occlusal status, and mean values were compared using the Kruskal-Wallis test. The mean age and body mass index were 72.2 ± 8.5 (50-89) years and 22.0 ± 3.6 (14.8-33.4), respectively. There were 42, 39, 23, and 10 patients in stages I, II, III, and IV, respectively. The mean number of remaining teeth was 18.1 ± 9.5. According to the Eichner classification, there were 45, 42, and 27 patients in groups A, B, and C, respectively. The GPS and neutrophil-lymphocyte ratio values and CONUT frequencies between groups A and C were significantly different (P = .033, P = .00097, P = .04, respectively; Mann-Whitney U test). PNI values were lower in group C with poor occlusal support zones than in group A with stable occlusal support zones.Occlusal supporting zone reductions were undernutrition associated. Eichner Class C patients with few occlusal supporting zones had poor GPS, PNI, and CONUT values and were undernourished.
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Affiliation(s)
- Atsushi Abe
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Yu Ito
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Hiroki Hayashi
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Atsushi Nakayama
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Hiroshi Furuta
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Moeko Momokita
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Hiroaki Hasegawa
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Akari Tsunoda
Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
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35
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Teixeira BH, Montevecchi I, Soares JDP, Siqueira JM, Pimentel GD. Charlson comorbidity index is not associated with neutrophil-lymphocytes ratio in unselected hospitalized cancer patients: A cross-sectional study. Exp Gerontol 2022; 163:111762. [PMID: 35240262 DOI: 10.1016/j.exger.2022.111762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022]
Abstract
This study sought to evaluate the association between Charlson Comorbidity Index (CCI) and neutrophil lymphocyte ratio (NLR). Cross-sectional study evaluated 134 patients of both sexes diagnosed with several types of cancer. NLR was calculated by dividing the absolute value of neutrophils by lymphocytes count, and the CCI questionnaire was used to assess the risk of comorbidities and mortality. The sample was dichotomized in CCI < 5 or ≥5. Student's t-test and Chi-square test were calculated to analyze the differences. The association between CCI and NLR was investigated by logistic regression analysis, performed with model 1 (crude) and model 2 (adjusted). The patients in the CCI ≥ 5 group were older, with higher neutrophil levels and prevalence of solid tumor type. There was no difference between groups regarding type of treatment, body weight, body mass index, performance status, lymphocyte count and NLR. There was no association between CCI and NLR, in both crude model (OR: 1.04 [95% CI: 0.99-1.09], p = 0.09), as well as adjusted for sex, age, physical activity, alcohol consumption, smoking habit, type of treatment, and performance status (OR: 1.04 [95% CI:0.97-1.12], p = 0.19). In hospitalized unselected cancer patients, despite of small sample size and design of study, we showed the presence of comorbidities is not related to the NLR.
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Affiliation(s)
- Brenna H Teixeira
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Isabel Montevecchi
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Jéssika D P Soares
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Jéssika M Siqueira
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | - Gustavo D Pimentel
- Laboratory of Research in Clinical Nutrition and Sports (Labince), Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil.
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Ortiz-López D, Acosta-Mérida MA, Casimiro-Pérez JA, Silvestre-Rodríguez J, Marchena-Gómez J. First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:142-148. [PMID: 34794921 DOI: 10.1016/j.rgmxen.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.
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Affiliation(s)
- D Ortiz-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - M A Acosta-Mérida
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - J A Casimiro-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J Silvestre-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J Marchena-Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
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Coppola A, La Vaccara V, Caggiati L, Carbone L, Spoto S, Ciccozzi M, Angeletti S, Coppola R, Caputo D. Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience. World J Gastrointest Surg 2021; 13:1216-1225. [PMID: 34754389 PMCID: PMC8554715 DOI: 10.4240/wjgs.v13.i10.1216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of preoperative inflammatory biomarkers (PIBs) in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery. However, data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy (PD) are less consistent. AIM To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy. METHODS A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed. Data regarding preoperative neutrophil-to-lymphocyte ratio (NLR), derived NLR and C-reactive protein (CRP), and postoperative complications of 238 cases have been evaluated. Exclusion criteria were: age < 18-years-old, previous neoadjuvant treatment, absence of data about PIBs, concomitant hematological disorders, and presence of active infections at the moment of the surgery. PIBs were compared using Mann-Whitney's test and receiver operating characteristic (ROC) analysis was performed to define the cutoffs. The positive predictive value (PPV) was computed to evaluate the probability to develop complication. P-values < 0.05 were considered statistically significant. RESULTS According to the literature findings, only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity. A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula (POPF) have been reported. The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF. According to our results, CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections (P < 0.05). Notably, patients with preoperative CRP > 8.81 mg/dL were at higher risk of both overall complications and abdominal collections (respectively P = 0.0037, PPV = 0.95, negative predictive value [NPV] = 0.27 and P = 0.016, PPV = 0.59, NPV = 0.68). Preoperative derived neutrophil-to-lymphocyte ratio (dNLR) (cut off > 1.47) was also a predictor of abdominal collection (P = 0.021, PPV = 0.48, NPV = 0.71). Combining CRP and dNLR, PPV increased to 0.67. NLR (cut off > 1.65) was significantly associated with postoperative hemorrhage (P = 0.016, PPV = 0.17, NPV = 0.98). CONCLUSION PIBs may predict complications after PD. During postoperative care, PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.
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Affiliation(s)
- Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Vincenzo La Vaccara
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Lorenza Caggiati
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Ludovico Carbone
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Spoto
- Department of Internal Medicine, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Massimo Ciccozzi
- Medical Statistics and Epidemiology Unit, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Roberto Coppola
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Damiano Caputo
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
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Sigmund IK, Puchner SE, Windhager R. Serum Inflammatory Biomarkers in the Diagnosis of Periprosthetic Joint Infections. Biomedicines 2021; 9:biomedicines9091128. [PMID: 34572314 PMCID: PMC8467465 DOI: 10.3390/biomedicines9091128] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Accurate preoperative diagnosis of periprosthetic joint infections (PJIs) can be very challenging, especially in patients with chronic PJI caused by low-virulence microorganisms. Serum parameters, such as serum C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), are—among other diagnostic test methods—widely used to distinguish septic from aseptic failure after total hip or knee arthroplasty and are recommended by the AAOS in the preoperative setting. However, they are systemic parameters, and therefore, unspecific. Nevertheless, they may be the first and occasionally the only preoperative indication, especially when clinical symptoms are lacking. They are easy to obtain, cheap, and are available worldwide. In the last decade, different novel serum biomarkers (percentage of neutrophils, neutrophils to lymphocytes ratio, platelet count to mean platelet volume ratio, fibrinogen, D-Dimer, Il-6, PCT) were investigated to find a more specific and accurate serum parameter in the diagnosis of PJI. This article reviews the diagnostic value of established (serum CRP, ESR, WBC) and ‘novel’ serum inflammatory biomarkers (fibrinogen, D-dimer, interleukin-6 (IL-6), procalcitonin, percentage of neutrophils (%N), neutrophils to lymphocytes ratio (NLR), platelet count to mean platelet volume ratio (PC/mPV)) for the preoperative diagnosis of periprosthetic joint infections.
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Yildirim M, Koca B. Lymphocyte C-reactive protein ratio: A new biomarker to predict early complications after gastrointestinal oncologic surgery. Cancer Biomark 2021; 31:409-417. [PMID: 34151845 DOI: 10.3233/cbm-210251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9-94.8) sensitivity, and 85.7% (73.6-95.4) selectivity. CONCLUSION Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.
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Xu H, Xie JW, Liu L, Wang D, Huang ZY, Zhou ZK. Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture. Bone Joint J 2021; 103-B:1534-1540. [PMID: 34223770 DOI: 10.1302/0301-620x.103b.bjj-2021-0105.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. METHODS We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. RESULTS The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. CONCLUSION The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients. Cite this article: Bone Joint J 2021;103-B(9):1534-1540.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Wei Xie
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Yu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Ciocan A, Ciocan RA, Al Hajjar N, Gherman CD, Bolboacă SD. Abilities of Pre-Treatment Inflammation Ratios as Classification or Prediction Models for Patients with Colorectal Cancer. Diagnostics (Basel) 2021; 11:diagnostics11030566. [PMID: 33801031 PMCID: PMC8003848 DOI: 10.3390/diagnostics11030566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Systemic inflammatory status is known as an important factor of colorectal cancer prognosis. Our study aimed to evaluate the performances of inflammation biomarker ratios as classification models of seven outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on subjects with colorectal cancer over five years at a single center in Transylvania, Romania. Seven derived ratios were calculated based on laboratory data: neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) and albumin-to-globulin (AGR) ratios, Systemic Immune Inflammation Index (SII) and Prognostic Nutritional Index (PNI). The utility of these ratios as predictors for seven outcomes was further evaluated in multivariable regression models. Results: Our study shows that the evaluated ratios exhibit specific performances for individual outcomes, proving a fair ability as screening tools (NLR and dNLR for survival, T stage and M stage; NLR and SII for T stage; and PLR for M stage). A dNLR over 3.1 (OR = 2.48, 95% CI (1.421 to 4.331)) shows predictive value for survival. A value of NLR over 3.10 (OR = 1.389, 95% CI (1.061 to 1.817)) is positively associated with an advanced T stage, while LMR is negatively related to the T stage (OR = 0.919, 95% CI (0.867 to 0.975)). NLR over 4.25 (OR = 2.647, 95% CI (2.128 to 3.360)) is positively associated with, while PNI is negatively related (OR = 0.970, 95% CI (0.947 to 0.993)) to, the M stage. Conclusion: Each of the evaluated ratios possesses prognostic value for certain outcomes considered, but the reported models need external validation to recommend their clinical practice utilization.
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Affiliation(s)
- Andra Ciocan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania;
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania;
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Răzvan A. Ciocan
- Department of Medical Skills—Human Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania;
- Correspondence: (R.A.C.); (S.D.B.)
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania;
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Claudia D. Gherman
- Department of Medical Skills—Human Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania;
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania;
- Correspondence: (R.A.C.); (S.D.B.)
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Pantoja Pachajoa DA, Gielis M, Palacios Huatuco RM, Benitez MN, Avila MN, Doniquian AM, Alvarez FA, Parodi M. Neutrophil-to-lymphocyte ratio vs C-reactive protein as early predictors of anastomotic leakage after colorectal surgery: A retrospective cohort study. Ann Med Surg (Lond) 2021; 64:102201. [PMID: 33763228 PMCID: PMC7973302 DOI: 10.1016/j.amsu.2021.102201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/28/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction Colorectal surgery (CRS) is associated with high morbidity rates, being anastomotic leakage (AL) one of the most serious complications with an incidence as high as 15%, accounting for up to a third of mortality in these procedures. The identification of pre-clinical markers may allow an early diagnosis and a timely intervention. The objective of the present study was to compare the performance of neutrophil-to-lymphocyte ratio (NLR) vs C-reactive protein (CRP) as early predictors of AL in CRS. Methods A retrospectively analyzed consecutive patients who underwent a colorectal surgery with anastomosis from June 2015 to April 2019. Receiver-operating characteristic (ROC) curves were used to find the cutoff points with the best diagnostic performance of AL. Results A total of 116 patients were included. From 43 patients (37%) who developed a total of 63 complications, 9 (7.76%) presented with an AL with a median of 8 days (range: 5–9). No significant differences were found for NLR between patients with vs without AL. In contrast, median CRP was significantly higher in patients who subsequently presented with AL, both on day 4 (164 vs 64, p = 0.04) and 5 (94 vs 44, p < 0.001) after surgery. The best predictive performance through ROC curves was found on postoperative day 5, with a CRP value of >54 mg/dL (AUC: 0.81, Sensitivity: 89%, Specificity: 61%). Conclusions CRP appears superior to NLR as an early predictor of AL following CRS. The best diagnostic performance was obtained on postoperative day 5 with a cutoff value of >54 mg/dL.
In the present study, CRP was found to be superior to NLR as an early predictor of clinically significant AL following CRS. The best predictive performance was obtained at postoperative day 5 with a cutoff value > 54 mg/dL. The importance of this finding may contribute during the hospital stay from the third postoperative day to the early diagnosis of LA.
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Ortiz-López D, Acosta-Mérida MA, Casimiro-Pérez JA, Silvestre-Rodríguez J, Marchena-Gómez J. First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(20)30155-5. [PMID: 33423817 DOI: 10.1016/j.rgmx.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/04/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was 266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.
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Affiliation(s)
- D Ortiz-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - M A Acosta-Mérida
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
| | - J A Casimiro-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - J Silvestre-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - J Marchena-Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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Ang JJ, Chia DKA, Chan DKH. Lymphocyte-White Cell Ratio Is a Novel Marker of Morbidity Following Colorectal Cancer Surgery. J Surg Res 2020; 259:71-78. [PMID: 33279846 DOI: 10.1016/j.jss.2020.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/25/2020] [Accepted: 11/01/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND A preoperative marker for morbidity in patients with colorectal cancer would help to risk stratify patients and allow for timely intervention to avert poor outcomes. We conducted this study to evaluate preoperative lymphocyte-white blood cell ratio (LWR) as a marker of postoperative morbidity. METHODS A prospective cohort of patients who underwent elective surgery for colorectal cancer was reviewed. Three morbidity-related outcomes were described-overall morbidity, multiple morbidities, and severe morbidity, defined as Clavien-Dindo Class ≥3. Univariable and multivariable analyses of presurgical predictors of these three outcomes were performed. Preoperative variables included hemoglobin levels, neoadjuvant therapy, albumin levels, white blood cell count, lymphocyte count, LWR, neutrophil-lymphocyte ratio, and prognostic nutritional index. RESULTS Of 177 patients, 31.6% (56/177) suffered at least one morbidity, 15.3% (27/177) had multiple morbidities, 7.9% (14/177) suffered severe morbidity. On multivariate analysis, only LWR <0.180 (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.15-5.55) and neoadjuvant therapy (OR 2.49, 95% CI 1.16-5.24) were associated with overall morbidity. For multiple morbidities and severe morbidity, only LWR <0.180 was significantly associated on multivariate analysis with an OR of 2.92 (95% CI 1.19-7.13) and 4.62 (95% CI 1.45-14.73), respectively. CONCLUSIONS LWR is a preoperative marker which can be conveniently applied using standard preoperative blood tests. LWR is an independent risk factor for overall morbidity, multiple morbidities, as well as severe morbidity when used with a cut-off of LWR<1.80.
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Affiliation(s)
- Jia Jun Ang
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Daryl Kai Ann Chia
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Yu BZ, Fu J, Chai W, Hao LB, Chen JY. Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection. BMC Musculoskelet Disord 2020; 21:706. [PMID: 33109144 PMCID: PMC7592373 DOI: 10.1186/s12891-020-03704-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. METHODS We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. RESULTS The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). CONCLUSIONS This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.
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Affiliation(s)
- Bao-Zhan Yu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China
- Department of Orthopaedics, Bao Ding GemFlower Eastern Hospital, Bao Ding, Hebei, P. R. China
| | - Jun Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China
| | - Wei Chai
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China
| | - Li-Bo Hao
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China.
| | - Ji-Ying Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China.
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Nogueira-Costa G, Fernandes I, Gameiro R, Gramaça J, Xavier AT, Pina I. Prognostic utility of neutrophil-to-lymphocyte ratio in patients with metastatic colorectal cancer treated using different modalities. Curr Oncol 2020; 27:237-243. [PMID: 33173374 PMCID: PMC7606052 DOI: 10.3747/co.27.6573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction Inflammation is a critical component in carcinogenesis. The neutrophil-to-lymphocyte ratio (nlr) has been retrospectively studied as a biomarker of prognosis in metastatic colorectal cancer (mcrc). Compared with a low nlr, a high nlr is associated with worse prognosis. In the present study, we compared real-world survival for patients with mcrc based on their nlr group, and we assessed the utility of the nlr in determining first-line chemotherapy and metastasectomy benefit. Methods In this retrospective and descriptive analysis of patients with mcrc undergoing first-line chemotherapy in a single centre, the last systemic absolute neutrophil and lymphocyte count before treatment was used for the nlr. A receiver operating characteristic curve was used to estimate the nlr cut-off value, dividing the patients into low and high nlr groups. Median overall survival (mos) was compared using Kaplan-Meier curves and the log-rank test. A multivariate analysis was performed using a Cox regression model. Results The 102 analyzed patients had a median follow-up of 15 months. Regardless of systemic therapy, approximately 20% of patients underwent metastasectomy. The nlr cut-off was established at 2.35, placing 45 patients in the low-risk group (nlr < 2.35) and 57 in the high-risk group (nlr ≥ 2.35). The Kaplan-Meier analysis showed a mos of 39.1 months in the low-risk group and 14.4 months in the high-risk group (p < 0.001). Multivariate Cox regression on the nlr estimated a hazard ratio of 3.08 (p = 0.01). Survival analysis in each risk subgroup, considering the history of metastasectomy, was also performed. In the low-risk group, mos was longer for patients undergoing metastasectomy than for those not undergoing the procedure (95.2 months vs. 22.6 months, p = 0.05). In the high-risk group, mos was not statistically different for patients undergoing or not undergoing metastasectomy (24.3 months vs. 12.7 months, p = 0.08). Conclusions Our real-world data analysis of nlr in patients with mcrc confirmed that this biomarker is useful in predicting survival. It also suggests that nlr is an effective tool to choose first-line treatment and to predict the benefit of metastasectomy.
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Affiliation(s)
| | - I Fernandes
- Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - R Gameiro
- Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - J Gramaça
- Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - A T Xavier
- Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - I Pina
- Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
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Nguyen JMV, Ferguson SE, Bernardini MQ, May T, Laframboise S, Hogen L, Bouchard-Fortier G. Preoperative neutrophil-to-lymphocyte ratio predicts 30 day postoperative morbidity and survival after primary surgery for ovarian cancer. Int J Gynecol Cancer 2020; 30:1378-1383. [PMID: 32788264 DOI: 10.1136/ijgc-2020-001378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The preoperative neutrophil-to-lymphocyte ratio has been found to be an independent prognostic indicator for perioperative complications and survival outcomes in patients undergoing oncologic surgery for several malignancies. The objective of this study was to evaluate the role of the preoperative neutrophil-to-lymphocyte ratio in predicting 30-day postoperative morbidity and overall survival in advanced-stage high-grade serous ovarian cancer patients after primary surgery. METHODS A retrospective study was conducted on consecutive patients who underwent primary surgery for high-grade serous ovarian cancer between January 2008 and December 2016 at a single tertiary academic institution in Toronto, Canada. Optimal thresholds for preoperative neutrophil-to-lymphocyte ratio were determined using receiver-operator characteristic curve analysis. Cox-proportional hazard models, Kaplan-Meier, and logistic regression analyses were performed. RESULTS Of 505 patients with ovarian cancer during the study period, 199 met the inclusion criteria. Receiver-operator characteristic curve analysis generated optimal preoperative neutrophil-to-lymphocyte ratio thresholds of 2.3 and 2.9 for 30-day postoperative morbidity and survival outcomes, respectively. A neutrophil-to-lymphocyte ratio ≥2.3 was predictive of a composite outcome of 30-day postoperative complications (odds ratio 7.3, 95% confidence interval 2.44 to 21.81; p=0.0004), after adjusting for longer operative time and intraoperative complications. Postoperative complications included superficial surgical site infections (p=0.007) and urinary tract infections (p=0.004). A neutrophil-to-lymphocyte ratio ≥29 was associated with worse 5-year overall survival (57.8% vs 77.7%, p=0.003), and suggested no statistically significant difference in progression-free survival (33.8% vs 40.7%, p=0.054). On multivariable analysis, the neutrophil-to-lymphocyte ratio remained an independent predictor for overall survival (p=0.02) when adjusting for suboptimal cytoreduction (p≤0.0001). DISCUSSION A preoperative neutrophil-to-lymphocyte ratio ≥2.3 and ≥2.9 is associated with greater risk of 30-day postoperative morbidity and worse overall survival, respectively. This marker may be used in conjunction with other risk assessment strategies to preoperatively identify high-risk patients. Further prospective study is required to investigate its role in clinical decision-making.
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Affiliation(s)
| | | | - Marcus Q Bernardini
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Taymaa May
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Stephane Laframboise
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Liat Hogen
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
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Caputo D, Coppola A, Cascone C, Angeletti S, Ciccozzi M, La Vaccara V, Coppola R. Preoperative systemic inflammatory biomarkers and postoperative day 1 drain amylase value predict grade C pancreatic fistula after pancreaticoduodenectomy. Ann Med Surg (Lond) 2020; 57:56-61. [PMID: 32714527 PMCID: PMC7374182 DOI: 10.1016/j.amsu.2020.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Postoperative day 1-drains amylase (POD1-DA) values are commonly used to predict the risk of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). Perioperative inflammatory biomarkers have been associated to higher risk of complications in different oncological surgeries. Aim of this study was to investigate the utility of the combination of preoperative inflammatory biomarkers (PIBs) with POD1-DA levels in predicting grade C PF. MATERIALS AND METHODS From a prospective collected database of 317 consecutive pancreaticoduodenectomies, data regarding POD1-DA levels and PIBs as neutrophil-to-lymphocyte ratio (NRL), derived neutrophil-to-lymphocyte ratio (dNRL), platelet-to-lymphocyte ratio (PLR) were analyzed in 227 cases. P-values <0.05 were considered statistically significant. Receiver operating characteristic (ROC) curves defined the optimal thresholds for biomarkers and drains amylase values and their accuracy to predict PF. Furthermore, the Positive Predictive Value (PPV) was computed to evaluate the probability to develop PF combining PIBs and drains amylase values. Combination of drains amylase and different PIBs cut-offs were used to evaluate the risk of grade C PF. RESULTS A POD1-DA level of 351 U/L significantly predicted PF (sensitivity 82.7%, specificity 76%, AUC 0.836; p < 0.001) with a PPV of 76.5% and a NPV of 82.6%.POD1-DA levels ≥807 U/L significantly predicted grade C PF (sensitivity 72.7%, specificity 64.4%, AUC 0.676; p = 0.004) with a PPV of 17.8% and a NPV of 95.6%.Notably, this last PPV increased from 17.8% to 89% when PIBs, at different cut-offs, were combined with POD1-DA at the value ≥ 807 U/L. CONCLUSION PIBs significantly improve POD1-DA ability in predicting grade C PF after PD.
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Affiliation(s)
- Damiano Caputo
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Roberto Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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Utsumi M, Aoki H, Nagahisa S, Nishimura S, Une Y, Kimura Y, Watanabe M, Taniguchi F, Arata T, Katsuda K, Tanakaya K. Preoperative C-Reactive Protein/Albumin Ratio as a Predictive Factor for Gallbladder Carcinoma. In Vivo 2020; 34:1901-1908. [PMID: 32606161 PMCID: PMC7439860 DOI: 10.21873/invivo.11986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM The C-reactive protein (CRP) to albumin ratio (CAR) is associated with outcomes in patients with sepsis. We aimed to evaluate the significance of preoperative CAR in therapeutic outcomes after gallbladder carcinoma (GBC) resection. PATIENTS AND METHODS Fifty-three patients who underwent surgical resection for GBC between January 2008 and September 2019 were enrolled. We retrospectively investigated the relation between preoperative CAR and overall and disease-free survival. RESULTS The optimal cut-off CAR was 0.07. Multivariate analysis showed that i) R1 or R2 resection (p=0.033), ii) advanced tumor stage (p=0.047), iii) CAR≥0.07 (p=0.011), and iv) postoperative complications (p=0.028) were significant independent predictors of overall survival; moreover, higher carbohydrate antigen levels (p=0.036) and R1 or R2 resection (p<0.001) were significant independent predictors of disease-free survival. CONCLUSION Preoperative CAR may be a significant independent predictor of long-term outcomes after GBC resection.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hideki Aoki
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seichi Nagahisa
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seitaro Nishimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuta Une
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuji Kimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Megumi Watanabe
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Fumitaka Taniguchi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Takashi Arata
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Koh Katsuda
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Kohji Tanakaya
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
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