全身炎症指标对预测结直肠癌术后早期并发症的价值

Q4 Medicine Medicina Pub Date : 2024-09-11 DOI:10.3390/medicina60091481
Irina Shevchenko, Catalin Cicerone Grigorescu, Dragos Serban, Bogdan Mihai Cristea, Laurentiu Simion, Florentina Gherghiceanu, Andreea Cristina Costea, Dan Dumitrescu, Catalin Alius, Corneliu Tudor, Minodora Onisai, Sebastian Gradinaru, Ana Maria Dascalu
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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). 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引用次数: 0

摘要

背景和目的:全身炎症指数在多种炎症、传染病和肿瘤疾病中的潜在预测价值已得到广泛研究,但其在结直肠癌中的价值仍是一个研究课题。本研究探讨结直肠癌患者术前和术后 NLR、PLR、SII 和 MLR 值的动态变化及其对术后早期预后的预测价值。材料与方法:对 200 名接受结直肠腺癌手术的患者进行了为期两年的回顾性队列研究。根据术前、术后第 1 天和第 6 天的全血细胞计数计算全身炎症指数。根据急诊或择期手术将患者分为两组。分别分析了两组患者术前和术后血清炎症生物标志物的数值及其与术后结果的相关性。结果显示两组患者在性别分布、发病率、相关合并症或手术类型方面没有明显差异。与择期手术患者相比,急诊组患者术前和术后的白细胞、中性粒细胞、NLR和SII值均较高。手术后的住院时间与术前和术后第一天和第六天的 NLR 值(p = 0.001;0.02;<0.001)、PLR 值(p <0.001)、SII 值(p = 0.037;<0.001;<0.001)和 MLR 值(p = 0.002;p = 0.002;<0.001)密切相关。在多变量分析中,急诊和贫血的再干预风险较高,而右侧结肠癌的再干预风险较低。在急诊组中,包括年龄、MLR PO1 和 pTNM 分期在内的多变量模型可预测严重的术后并发症(AUC ROC 0.818)。术后第一天的炎症指数与脓毒症有很好的相关性,术后第一天的 NLR(AUC 0.836;敏感性 88.8%;特异性 66.7%)和 SII(AUC 0.796;敏感性 66.6%;特异性 90%)具有最佳预测价值。对于择期手术患者,术后第一天的 PLR 和贫血被纳入多变量模型,以预测 Clavien-Dindo 3 级或以上并发症(AUC ROC 0.818)和再干预(AUC ROC 0.796)。结论易于计算且价格低廉的全身炎症生物标志物可用于预测结直肠癌择期手术和急诊手术的术后早期预后。
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The Value of Systemic Inflammatory Indices for Predicting Early Postoperative Complications in Colorectal Cancer
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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来源期刊
Medicina
Medicina Medicine-Medicine (all)
CiteScore
0.10
自引率
0.00%
发文量
66
审稿时长
24 weeks
期刊介绍: Publicada con el apoyo del Ministerio de Ciencia, Tecnología e Innovación Productiva. Medicina no tiene propósitos comerciales. El objeto de su creación ha sido propender al adelanto de la medicina argentina. Los beneficios que pudieran obtenerse serán aplicados exclusivamente a ese fin.
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