Can We Predict Gastric Leaks After Laparoscopic Sleeve Gastrectomy by Evaluating the Complete Blood Count on Postoperative Day 1?

Hakan Seyit, Fahri Gokcal, Halil Alis
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Abstract

Introduction: We assessed whether postoperative day-1 (POD-1) complete blood count (CBC) test parameters, including red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), could identify patients with gastric leaks after laparoscopic sleeve gastrectomy (LSG).

Methods: Patients with postoperative gastric leaks (n=36) and patients with no complications who were selected by age-sex-BMI matching (n=254) were included in the study. The levels of RDW, MPW, PCT, PLR, and NLR were compared between groups in univariate analyses. Receiver operating characteristic (ROC) curve analysis was run for CBC parameters with a P -value<0.05 in univariate analyses. The area under the curve (AUC) was evaluated, and a cutoff value was determined. Sensitivity, specificity, likelihood ratio (LR), positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results: The level of PCT was significantly lower, while levels of PLR and NLR were significantly higher in patients with postoperative gastric leaks as compared with those without ( P <0.05). The AUC of both PCT and PLR was <0.750, while the AUC of NLR was 0.911. NLR cutoff at 3.6 yielded 80% sensitivity, 92% specificity, and an LR of 10. In the study cohort, PPV of 59%, NPV of 97%, and an accuracy of 90% were found.

Conclusions: Our results suggest that NLR at POD-1, with a cutoff value of 3.6, is a useful indicator of postoperative gastric leak who underwent LSG. We recommend the use of this easily calculated parameter in clinical practice.

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我们能否通过评估术后第 1 天的全血细胞计数来预测腹腔镜袖带胃切除术后的胃漏?
导言:我们评估了术后第1天(POD-1)全血细胞计数(CBC)检验参数,包括红细胞分布宽度(RDW)、平均血小板体积(MPV)、血小板比容(PCT)、血小板与淋巴细胞比值(PLR)和中性粒细胞与淋巴细胞比值(NLR),是否能识别腹腔镜袖状胃切除术(LSG)后胃漏患者:研究纳入了术后胃漏患者(36 人)和通过年龄-性别-体重指数匹配筛选出的无并发症患者(254 人)。在单变量分析中比较了不同组间的 RDW、MPW、PCT、PLR 和 NLR 水平。用 P 值对 CBC 参数进行了接收者操作特征(ROC)曲线分析:与无胃漏患者相比,术后胃漏患者的 PCT 水平明显较低,而 PLR 和 NLR 水平则明显较高:我们的研究结果表明,POD-1 时的 NLR(临界值为 3.6)是判断 LSG 术后胃漏的有效指标。我们建议在临床实践中使用这一易于计算的参数。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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