Neutrophil-to-lymphocyte ratio may predict complications and patency in bile duct injury repair

IF 1.5 4区医学 Q3 SURGERY ANZ Journal of Surgery Pub Date : 2024-07-26 DOI:10.1111/ans.19104

Gustavo Martinez-Mier MD, FACS, Regina Carbajal-Hernández MD, Mario López-García MD, Jorge A. Vázquez-Ramirez MD, José M. Reyes-Ruiz PhD, Jose R. Solórzano-Rubio MD, José L. González-Grajeda MD, Pedro I. Moreno-Ley MD

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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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中性粒细胞与淋巴细胞比率可预测胆管损伤修复的并发症和通畅性。

背景：胆管损伤（BDI）修复手术通常与发病率/死亡率相关。中性粒细胞与淋巴细胞比值（NLR）可轻松评估患者的炎症状态。本研究旨在确定术前 NLR（pNLR）与 BDI 修复手术术后结果之间可能存在的关系：经伦理/研究委员会批准的回顾性研究，对象为接受过 Bismuth-Strasberg E 型 BDI 修复手术的患者（2008-2023 年）。登记的数据包括：发病率、死亡率和长期疗效（初次通畅和初次通畅丧失）（Kaplan-Meier）。对 pNLR 的评估采用了组间比较（U Mann-Whitney）、接收器操作者特征（ROC）：曲线下面积 [AUC]、临界值和尤登指数 [J]，以及逻辑回归分析：研究了 73 名患者。平均年龄为 44.4 岁。E2是最常见的BDI（38.4%）。围手术期发病率/死亡率分别为31.5%和1.4%。初次通畅率为 95.9%。8.2%丧失了初次通畅率（3年精算通畅率：85.3%）。任何并发症患者（4.84 对 2.89 p = 0.015）、胆道并发症患者（5.29 对 2.86 p = 0.01）和丧失初次通畅患者（5.22 对 3.1 p = 0.08）的中位 pNLR 均较高。AUC值、临界值和（J）分别为：任何并发症（0.678，pNLR = 4.3，J = 0.38，p = 0.007）、严重并发症（0.667，pNLR = 4.3，J = 0.34，p = 0.04）、胆道并发症（0.712，pNLR = 3.64，J = 0.46，p = 0.001）和原发性通畅丧失（0.716，pNLR = 3.24，J = 0.52，p = 0.008）。逻辑回归对任何并发症（Exp [B]：0.1，p = 0.002）、严重并发症（Exp [B]：0.2，p = 0.03）和胆道并发症（Exp [B]：8.1，p = 0.003）均有显著意义。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.