Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery.
Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery.
复制标题
DOI：
10.21037/jgo-21-812
复制
发表时间：
2021-01
影响因子：
2.1
通讯作者：
Cai-xia Wu;Ding-Yu Rao;Chengpeng Sang;Shenjun Zhu;Liang Gu;Yanxin Wu;Jian-Feng Wang;Hua-Qiu Shi;Xiangcheng Wang;Zhi-xian Tang
中科院分区：
文献类型：
--
作者：
Cai-xia Wu;Ding-Yu Rao;Chengpeng Sang;Shenjun Zhu;Liang Gu;Yanxin Wu;Jian-Feng Wang;Hua-Qiu Shi;Xiangcheng Wang;Zhi-xian Tang
背景本研究调查了外周炎症指标，包括中性粒细胞计数、淋巴细胞计数、血小板计数、嗜中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率（PLR）在择期食管手术吻合口瘘中的预测价值。方法回顾性分析2016年至2020年在我院行食管鳞癌切除术的所有患者。在术前1-7天（PRD 1-7）、术后1-3天（POD 1-3）和4-7天（POD 4-7）获得外周血炎症指数。进行单因素、多因素Logistic和受试者工作特征曲线分析，以评价这些外周血炎症指标的诊断价值。结果共198例患者入组研究，25例（13%）患者发生吻合口瘘。多变量分析确定饮食、中性粒细胞计数和术后第1-3天PLR以及术后第4-7天NLR是与吻合口漏相关的独立因素。使用受试者工作特征曲线，具有最佳曲线下面积的变量是中性粒细胞临界计数4.1 [0.737; 95%CI：0.639-0.835]，灵敏度和特异性分别为60.0%和66.5%。随后，POD 4-7的NLR临界值为9.5（0.628; 95% CI：0.505-0.752），POD 1-3的PLR临界值为220.1（0.643; 95% CI：0.536-0.750）。饮食在受试者工作特征曲线分析中显示出较差的结果。结论食管癌术后1-3天的中性粒细胞计数、PLR和4-7天的NLR对食管癌术后吻合口瘘的发生有一定的预测价值。
Background This study investigated the predictive value of peripheral inflammatory indices, including neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in anastomotic leakage during elective esophageal surgery. Methods This retrospective study included all patients who underwent esophagectomy for esophageal squamous cell carcinoma from 2016 to 2020 in our institution. The peripheral blood inflammatory indices were obtained on preoperative days 1-7 (PRD 1-7), and postoperative days 1-3 (POD 1-3) and 4-7 (POD 4-7). Univariate, multivariate logistic, and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic value of these peripheral blood inflammatory indices. Results A total of 198 patients were included in the study, and 25 (13%) patients experienced anastomotic leakage. Multivariate analyses identified diet, neutrophil count, and PLR on POD 1-3, and NLR on POD 4-7 as independent factors associated with anastomotic leakage. Using the receiver operating characteristic curve, the variable with the best area under curve was a neutrophil cutoff count of 4.1 [0.737; 95% CI: 0.639-0.835], with a sensitivity and specificity of 60.0% and 66.5%, respectively. This was followed by an NLR cutoff value of 9.5 on POD 4-7 (0.628; 95% CI: 0.505-0.752) and a cutoff PLR value of 220.1 on POD 1-3 (0.643; 95% CI: 0.536-0.750). Diet showed a poor result on the receiver operating characteristic curve analysis. Conclusions Neutrophil count and PLR on POD 1-3 and NLR on POD 4-7 were shown to have predictive value for anastomotic leakage in elective esophageal surgery.