Simpson G, Saunders R, Wilson J, Magee C
Division of GI Surgery, Wirral University Teaching Hospitals, Wirral, UK.
University of Liverpool Division of Oncology and Surgery, Liverpool, UK.
Eur J Trauma Emerg Surg. 2018 Dec;44(6):877-882. doi: 10.1007/s00068-017-0869-4. Epub 2017 Nov 13.
Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.
A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.
One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.
Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.
老年患者的急诊剖腹手术是一种越来越常见的手术，其发病率和死亡率都很高。风险预测工具虽然并不完美，但有助于指导管理决策。手术结果的新标志物可能有助于这些评分系统。中性粒细胞与淋巴细胞比值（NLR）和CRP与白蛋白比值（CAR）已与恶性肿瘤和脓毒症的预后相关。我们评估了NLR和CAR比值作为80岁以上接受急诊剖腹手术患者的预后指标的应用情况。
对3年内所有80岁以上接受急诊剖腹手术的患者进行回顾性分析。评估术前和术后NLR和CAR与包括住院患者、30天和90天死亡率在内的预后指标的关系。采用曼-惠特尼U检验、受试者工作特征曲线、斯皮尔曼等级相关系数和卡方检验进行统计分析。
136例80岁以上患者接受了急诊剖腹手术。中位年龄为84岁（范围80 - 96岁）。总体住院死亡率为19.2%。脓毒症患者与无脓毒症患者相比，术前和术后NLR和CAR显著升高（p < 0.05）。在内脏穿孔患者中，术前NLR与住院患者死亡率（p = 0.046）、30天死亡率（p = 0.02）和90天死亡率（p = 0.01）显著相关。术前NLR值大于8与死亡率显著增加相关（p = 0.016，AUC：0.78）。CAR与死亡率无关。
术前NLR与接受急诊剖腹手术的内脏穿孔患者的死亡率相关。NLR > 8与该组患者较差的预后相关。在80岁以上接受急诊剖腹手术的患者中，CAR与死亡率无关。
