Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

Panagiotis Paliogiannis, Simona Deidda, Svilen Maslyankov, Tsvetelina Paycheva, Ahmed Farag, Abdrabou Mashhour, Evangelos Misiakos, Dimitrios Papakonstantinou, Michal Mik, Joanna Losinska, Fabrizio Scognamillo, Fabio Sanna, Claudio Francesco Feo, Giuseppe Cherchi, Andreas Xidas, Angelo Zinellu, Angelo Restivo, Luigi Zorcolo, Panagiotis Paliogiannis, Simona Deidda, Svilen Maslyankov, Tsvetelina Paycheva, Ahmed Farag, Abdrabou Mashhour, Evangelos Misiakos, Dimitrios Papakonstantinou, Michal Mik, Joanna Losinska, Fabrizio Scognamillo, Fabio Sanna, Claudio Francesco Feo, Giuseppe Cherchi, Andreas Xidas, Angelo Zinellu, Angelo Restivo, Luigi Zorcolo

Abstract

Background: The aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery.

Methods: Demographic, pathologic, and clinical data of 1432 consecutive patients submitted to colorectal surgery in eight surgical centers were retrospectively evaluated. The neutrophil to lymphocyte (NLR), derived neutrophil to lymphocyte (dNLR), lymphocyte to monocyte (LMR), and platelet to lymphocyte (PLR) ratios were calculated before surgery and on the 1st and 4th postoperative days, in patients with or without AL.

Results: There were 106 patients with AL (65 males, mean age 67.4 years). The NLR, dNLR, and PLR were significantly higher in patients with AL in comparison to those without, on both the 1st and 4th postoperative days, but significance was greater on the 4th postoperative day. An NLR cutoff value of 7.1 on this day showed the best area under the curve (AUC 0.744; 95% CI 0.719-0.768) in predicting AL.

Conclusions: Among the blood cell indexes of inflammation evaluated, NLR on the 4th postoperative day showed the best ability to predict AL. NLR is a low cost, easy to perform, and widely available index, which might be potentially used in clinical practice as a predictor of AL in patients undergoing elective colorectal surgery.

Keywords: Anastomotic leakage; Colorectal surgery; LMR; NLR; PLR.

Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
ROC curves of NLR, dNLR, and PLR in predicting anastomotic leakage

References

    1. Matthiessen P, Henriksson M, Hallbook O, Grunditz E, Noren B, Arbman G. Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection. Colorectal Dis. 2008;10:75–80. doi: 10.1111/j.1463-1318.2007.01452.x.
    1. Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, Zaharie FV, Osian G, Puia CI, Muntean V. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointest Liver Dis. 2008;17:299–303.
    1. Michaels AL, Mullen MG, Guidry CA, Krebs ED, Turrentine FE, Hedrick TL, Friel CM. Unplanned reoperation following colorectal surgery: indications and operations. J Gastrointest Surg. 2017;21:1480–1485. doi: 10.1007/s11605-017-3447-5.
    1. Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013;148:65–71. doi: 10.1001/2013.jamasurg.2.
    1. Ashraf SQ, Burns EM, Jani A, Altman S, Young JD, Cunningham C, Faiz O, Mortensen NJ. The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them? Colorectal Dis. 2013;15:190–198. doi: 10.1111/codi.12125.
    1. Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg. 2017;41:277–284. doi: 10.1007/s00268-016-3761-1.
    1. Paliogiannis P, Attene F, Scognamillo F, Trignano E, Torre C, Pulighe F, Trignano M. Conservative management of minor anastomotic leakage after open elective colorectal surgery. Ann Ital Chir. 2012;83:25–28.
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup Surviving sepsis campaign guidelines committee including the pediatric subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2013;39:165–228. doi: 10.1007/s00134-012-2769-8.
    1. Su’a BU, Mikaere HL, Rahiri JL, Bissett IB, Hill AG. Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery. Br J Surg. 2017;104:503–512. doi: 10.1002/bjs.10487.
    1. Mik M, Dziki L, Berut M, Trzcinski R, Dziki A. Neutrophil to lymphocyte ratio and C-reactive protein as two predictive tools of anastomotic leak in colorectal cancer open surgery? Dig Surg. 2018;35:77–84. doi: 10.1159/000456081.
    1. Tang H, Li B, Zhang A, Lu W, Xiang C, Dong J. Prognostic significance of neutrophil-to-lymphocyte ratio in colorectal liver metastasis: a systematic review and meta-analysis. PloS One. 2016;11:e0159447. doi: 10.1371/journal.pone.0159447.
    1. Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, Dong J, Cheng JW, Liu ZW, Ma L, Lv Y. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134:2403–2413. doi: 10.1002/ijc.28536.
    1. Madonia M, Paliogiannis P, Solinas T, Mangoni AA, Carru C, Zinellu A. Neutrophil to lymphocyte ratio and muscular invasion in early-stage bladder cancer: a meta-analysis. Eur J Oncol. 2018;23:65–71.
    1. Paliogiannis P, Scognamillo F, Bellomo M, Pittalis ML, Pisano IP, Karligkiotis A, Bozzo C, Sotgiu G, Attene F. Neutrophil to lymphocyte ratio as a predictor of thyroid papillary carcinoma. Acta Med Mediterr. 2015;31:371–375.
    1. Miyakita H, Sadahiro S, Saito G, Okada K, Tanaka A, Suzuki T. Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery. Int J Clin Oncol. 2017;22:324–331. doi: 10.1007/s10147-016-1054-1.
    1. Vaughan-Shaw PG, Rees JR, King AT. Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. Int J Surg. 2012;10:157–162. doi: 10.1016/j.ijsu.2012.02.010.
    1. Giakoumidakis K, Fotos NV, Patelarou A, Theologou S, Argiriou M, Chatziefstratiou AA, Katzilieri C, Brokalaki H. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes. Pragmat Obs Res. 2017;8:9–14. doi: 10.2147/POR.S130560.
    1. Mohri Y, Tanaka K, Toiyama Y, Ohi M, Yasuda H, Inoue Y, Kusunoki M. Impact of preoperative neutrophil to lymphocyte ratio and postoperative infectious complications on survival after curative gastrectomy for gastric cancer: a single institutional cohort study. Medicine (Baltimore) 2016;95:e3125. doi: 10.1097/MD.0000000000003125.
    1. Lan H, Zhou L, Chi D, Zhou Q, Tang X, Zhu D, Yue J, Liu B. Preoperative platelet to lymphocyte and neutrophil to lymphocyte ratios are independent prognostic factors for patients undergoing lung cancer radical surgery: a single institutional cohort study. Oncotarget. 2017;8:35301–35310.
    1. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, Tsubosa Y, Satoh T, Yokomizo A, Fukuda H, Sasako M. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–685. doi: 10.1007/s00595-015-1236-x.
    1. Vasiliu EC, Zarnescu NO, Costea R, Neagu S. Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia (Bucur). 2015;110:319–326.
    1. Huang XZ, Chen WJ, Zhang X, Wu CC, Zhang CY, Sun SS, Wu J. An elevated platelet-to-lymphocyte ratio predicts poor prognosis and clinicopathological characteristics in patients with colorectal cancer: a meta-analysis. Dis Markers. 2017;2017:1053125.
    1. Lin ZX, Ruan DY, Li Y, Wu DH, Ma XK, Chen J, Chen ZH, Li X, Wang TT, Lin Q, Wen JY, Wu XY. Lymphocyte-to-monocyte ratio predicts survival of patients with hepatocellular carcinoma after curative resection. World J Gastroenterol. 2015;21:10898–10906. doi: 10.3748/wjg.v21.i38.10898.
    1. Facciorusso A, Del Prete V, Crucinio N, Serviddio G, Vendemiale G, Muscatiello N. Lymphocyte-to-monocyte ratio predicts survival after radiofrequency ablation for colorectal liver metastases. World J Gastroenterol. 2016;22:4211–4218. doi: 10.3748/wjg.v22.i16.4211.
    1. Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, Negri S, Carru C, Zinellu A. Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev. 2018;27:147. doi: 10.1183/16000617.0113-2017.
    1. Paliogiannis P, Zinellu A, Mangoni AA, Capobianco G, Dessole S, Cherchi PL, Carru C. Red blood cell distribution width in pregnancy: a systematic review. Biochem Med (Zagreb) 2018;28:030502. doi: 10.11613/BM.2018.030502.
    1. Silberman S, Abu-Yunis U, Tauber R, Shavit L, Grenader T, Fink D, Bitran D, Merin O. Neutrophil-lymphocyte ratio: prognostic impact in heart surgery. Early outcomes and late survival. Ann Thorac Surg. 2018;105:581–586. doi: 10.1016/j.athoracsur.2017.07.033.
    1. Paliogiannis P, Ginesu GC, Tanda C, Feo CF, Fancellu A, Fois AG, Mangoni AA, Sotgia S, Carru C, Porcu A, Zinellu A. Inflammatory cell indexes as preoperative predictors of hospital stay in open elective thoracic surgery. ANZ J Surg. 2018;88:616–620. doi: 10.1111/ans.14557.
    1. Josse JM, Cleghorn MC, Ramji KM, Jiang H, Elnahas A, Jackson TD, Okrainec A, Quereshy FA. The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery. Colorectal Dis. 2016;18:O236–O242. doi: 10.1111/codi.13373.
    1. Walker PA, Kunjuraman B, Bartolo DCC. Neutrophil-to-lymphocyte ratio predicts anastomotic leakage. ANZ J Surg. 2018. 10.1111/ans.14369.
    1. Paliogiannis P, Feo CF, Scognamillo F, Mulas S, Xidas A, Zinellu A, Carru C, Porcu A. Re: Neutrophil-to-lymphocyte ratio predicts anastomotic leakage. ANZ J Surg. 2018;88:939. doi: 10.1111/ans.14767.
    1. Paliogiannis P, Attene F, Porcu A, Cossu ML, Fancellu A, Scanu AM, Ginesu GC, Cherchi G, Niolu P, Coppola M, Carru C, Zinellu A. Red cell distribution width and mean platelet volume as predictors of anastomotic leakage in colorectal surgery a pilot multicenter case-match study. Ann Ital Chir. 2018;89:419–424.

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