Is the Neutrophil-to-Lymphocyte Ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery?

Patrice Forget, Valérie Dinant, Marc De Kock, Patrice Forget, Valérie Dinant, Marc De Kock

Abstract

Background. The Neutrophil-to-Lymphocyte Ratio (NLR) is an inflammatory marker that has proven usefulness for predicting late complications. Whether it is associated with immediate postoperative complications after abdominal surgery is not known. In this study, we attempted to correlate the NLR and the C-reactive protein (CRP) with postoperative complications rate. Methods. We performed a post-hoc analysis of previously collected data concerning 82 consecutive patients (median age: 62 years, range: 27-80, female/male 32/50) undergoing major abdominal surgeries. For each patient, we recorded preoperative characteristics, the NLR and CRP values, and postoperative complications (between D + 8 and D + 30) such as infections (N = 29), cardiovascular complications (N = 12) and other complications (N = 28). We performed uni- and multivariate analyses using logistic/linear regression models. Results. Patients with complications did not present a higher preoperative NLR than those without, but a higher ratio at D + 7 (10.73 ± 9.86 vs. 4.73 ± 3.38 without complication) (P < 0.001). In the univariate analysis, the NLR at D + 7 was associated with postoperative complications (P < 0.001). At D + 7, in the multivariate analysis, an increased NLR was associated with more complications (P < 0.001), whereas none of the other factors, including CRP, showed any correlation. Conclusion. Postoperative NLR at day 7 after major abdominal surgery is associated with complications during the first postsurgical month, in contrast with the CRP level. The NLR is a simple and interesting parameter in the perioperative period.

Keywords: C-reactive protein; Neutrophil-to-lymphocyte ratio; Postoperative complications.

Figures

Figure 1. (A) C-reactive protein (CRP) and…
Figure 1. (A) C-reactive protein (CRP) and (B) Neutrophil-to-Lymphocyte ratio (NLR) values in 82 patients: preoperatively, at day + 1 (D1), day + 2 (D2) and day + 7 (D7), and presenting (or not) postoperative complications after major abdominal surgery.
Data are presented as mean ± SEM. P-value after (paired) Student t-tests.

References

    1. Carli F, Annetta MG. Conséquences immunologiques de la chirurgie et de l’anesthésie: mécanismes et modalités thérapeutiques. Le Praticien en Anesthésie Reanimation. 2003;7(4):231–247.
    1. Chiang SF, Hung HY, Tang R, Changchien CR, Chen JS, You YT, Chiang JM, Lin JR. Can neutrophil to lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively? International Journal of Colorectal Disease. 2012;27(10):1347–1357. doi: 10.1007/s00384-012-1459-x.
    1. Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. British Journal of Cancer. 2011;104(8):1288–1295. doi: 10.1038/bjc.2011.100.
    1. Ding PR, An X, Zhang RX, Fang YJ, Li LR, Chen G, Wu XJ, Lu ZH, Lin JZ, Kong LH, Wan DS, Pan ZZ. Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer. International Journal of Colorectal Disease. 2010;25(12):1427–1433. doi: 10.1007/s00384-010-1052-0.
    1. Forget P, Lois F, De Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesthesia and Analgesia. 2010;111(4):910–914. doi: 10.1213/ANE.0b013e3181eb624f.
    1. Forget P, Machiels JP, Coulie PG, Berliere M, Poncelet AJ, Tombal B, Stainier A, Legrand C, Canon JL, Kremer Y, De Kock M. Neutrophil: lymphocyte Ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung and kidney cancer surgery. Annals of Surgical Oncology. 2013;20(3-Suppl):650–660. doi: 10.1245/s10434-013-3136-x.
    1. Huang ZL, Luo J, Chen MS, Li JQ, Shi M. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization. Journal of Vascular and Interventional Radiology. 2011;22(5):702–709. doi: 10.1016/j.jvir.2010.12.041.
    1. Keizman D, Ish-Shalom M, Huang P, Eisenberger MA, Pili R, Hammers H, Carducci MA. The association of pre-treatment neutrophil to lymphocyte ratio with response rate, progression free survival, and overall survival of patients treated with sunitinib for metastatic renal cell carcinoma. European Journal of Cancer. 2012;48(2):202–208. doi: 10.1016/j.ejca.2011.09.001.
    1. Kim HS, Han KH, Chung HH, Kim JW, Park NH, Song YS, Kang SB. Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison. European Journal of Surgical Oncology. 2010;36(7):691–698. doi: 10.1016/j.ejso.2010.05.004.
    1. Kim WH, Jin HS, Ko JS, Hahm TS, Lee SM, Cho HS, Kim MH. The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy-assisted vaginal hysterectomy. Acta Anaesthesiologica Taiwanica. 2011;49(3):83–87. doi: 10.1016/j.aat.2011.08.004.
    1. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, McMillan DC. A comparison of inflammation-based prognosis scores in patients with cancer. A Glasgow inflammation outcome study. European Journal of Cancer. 2011;47(17):2633–2641. doi: 10.1016/j.ejca.2011.03.028.
    1. Sharaiha RZ, Halazun KJ, Mirza F, Port JL, Lee PC, Neugut AI, Altorki NK, Abrams JA. Elevated preoperative neutrophil:lymphocyte ratio as a predictor of post-operative disease recurrence in esophageal cancer. Annals of Surgical Oncology. 2011;18(12):3362–3369. doi: 10.1245/s10434-011-1754-8.
    1. Sido B, Teklote JR, Hartel M, Friess H, Büchler MW. Inflammatory response after abdominal surgery. Best Practice & Research Clinical Anaesthesiology. 2004;18(3):439–454. doi: 10.1016/j.bpa.2003.12.006.
    1. Tabuchi T, Shimazaki J, Satani T, Nakachi T, Watanabe Y, Tabuchi T. The perioperative granulocyte/lymphocyte ratio is a clinical relevant marker of surgical stress in patients with colorectal cancer. Cytokine. 2011;53(2):243–248. doi: 10.1016/j.cyto.2010.10.004.
    1. Vaughan-Shaw PG, Rees JR, King AT. Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. International Journal of Surgery. 2012;10:157–162. doi: 10.1016/j.ijsu.2012.02.010.
    1. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. Journal of Surgical Oncology. 2005;91(3):181–184. doi: 10.1002/jso.20329.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する