West London Gynecological Cancer Centre, Imperial College Healthcare NHS Trust, London, UK
Gynaecological Oncology Department of Alexandra University Hospital, Medical School of University of Athens, Athens, Greece.
Int J Gynecol Cancer. 2019 Oct;29(8):1292-1297. doi: 10.1136/ijgc-2019-000712. Epub 2019 Sep 2.
Splenectomy-induced thrombocytosis and leukocytosis may obscure the early diagnosis of post-operative infection or sepsis. In trauma patients after splenectomy, a platelet-to-white blood cell ratio of <20 has been shown to reliably differentiate post-operative sepsis from transient physiological responses.
To determine whether the platelet-to-white blood cell ratio can be applied to differentiate between reactive post-operative changes and latent infection.
All consecutive patients with ovarian cancer who underwent splenectomy between January 2013 and October 2018 in two large European gynecological cancer centers were retrospectively evaluated. Main outcome measures were white blood cell count, platelet count, and platelet-to-white blood cell ratio on post-operative days 1, 5, and 7. These were correlated with surgical outcome and morbidity according to the Clavien-Dindo classification. A binomial logistic regression was applied to assess the predictive value of day 5 platelet-to-white blood cell ratio, white blood cell count, and platelet count for predicting grade III post-operative sepsis.
Ninety-five patients with ovarian cancer (mean age 54 years, range 18-75) were identified. Seventeen patients (17.9%) developed a grade III post-operative sepsis. In all post-operative patients, mean white blood cell count on day 5 decreased (from 15.4×10/μL to 11.4×10/μL), while the mean platelet count rose (from 260.7×10/μL to 385.3×10/μL). A high platelet count (>313×10/μL) failed to show any predictive value (OR=0.94; 95% CI 0.30 to 3.0; p=0.921). A low platelet-to-white blood cell ratio (<26) (OR=3.49; 95% CI 1.18 to 10.32; p=0.0241) and high white blood cell count (>14.5×10/μL) on day 5 (OR=11.0; 95% CI 3.3 to 36.2; p<0.001) were significant for predicting sepsis. Despite a significant OR, the sensitivity and specificity were low; day 5 platelet-to-white blood cell ratio at a cut-off point of 26 achieved a sensitivity of 72% and specificity of 53% (area under the curve 0.637, 95% CI 0.480 to 0.796) in predicting grade III post-operative sepsis.
Platelet-to-white blood cell ratio after cytoreductive surgery for ovarian cancer with splenectomy does not appear to have a strong predictive value in differentiating between sepsis and reactive splenectomy-induced changes. Leukocytosis, in combination with clinical assessment, may remain the most useful tool for prediction of sepsis after cytoreductive surgery with splenectomy.
脾切除术后引起的血小板增多症和白细胞增多症可能会掩盖术后感染或败血症的早期诊断。在脾切除术后的创伤患者中，血小板与白细胞比值<20 已被证明可可靠地区分术后败血症与短暂的生理反应。
确定血小板与白细胞比值是否可用于区分反应性术后变化和潜在感染。
回顾性分析 2013 年 1 月至 2018 年 10 月期间在两个大型欧洲妇科癌症中心接受脾切除术的所有连续卵巢癌患者。主要观察指标为术后第 1、5 和 7 天的白细胞计数、血小板计数和血小板与白细胞比值。根据 Clavien-Dindo 分类，将这些与手术结果和发病率相关联。应用二项逻辑回归评估术后第 5 天血小板与白细胞比值、白细胞计数和血小板计数对预测 III 级术后败血症的预测价值。
确定了 95 例卵巢癌患者（平均年龄 54 岁，范围 18-75 岁）。17 例（17.9%）发生 III 级术后败血症。在所有术后患者中，第 5 天的平均白细胞计数从 15.4×10/μL 下降至 11.4×10/μL，而平均血小板计数从 260.7×10/μL 上升至 385.3×10/μL。高血小板计数（>313×10/μL）没有显示出任何预测价值（OR=0.94；95%CI 0.30 至 3.0；p=0.921）。低血小板与白细胞比值（<26）（OR=3.49；95%CI 1.18 至 10.32；p=0.0241）和第 5 天的高白细胞计数（>14.5×10/μL）（OR=11.0；95%CI 3.3 至 36.2；p<0.001）是预测败血症的显著因素。尽管 OR 显著，但敏感性和特异性均较低；血小板与白细胞比值在 26 时的截断值在预测 III 级术后败血症方面的敏感性为 72%，特异性为 53%（曲线下面积 0.637，95%CI 0.480 至 0.796）。
卵巢癌伴脾切除的细胞减灭术后血小板与白细胞比值似乎对区分败血症与反应性脾切除术后变化没有很强的预测价值。白细胞增多症与临床评估相结合，可能仍然是预测脾切除术后细胞减灭术并发败血症的最有用工具。
