Pantoja Pachajoa Diana A, Gielis Manuel, Palacios Huatuco René M, Benitez Milagros N, Avila Micaela N, Doniquian Alejandro M, Alvarez Fernando A, Parodi Matías
General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo, 1248, Córdoba Capital, Argentina.
Ann Med Surg (Lond). 2021 Mar 5;64:102201. doi: 10.1016/j.amsu.2021.102201. eCollection 2021 Apr.
Colorectal surgery (CRS) is associated with high morbidity rates, being anastomotic leakage (AL) one of the most serious complications with an incidence as high as 15%, accounting for up to a third of mortality in these procedures. The identification of pre-clinical markers may allow an early diagnosis and a timely intervention. The objective of the present study was to compare the performance of neutrophil-to-lymphocyte ratio (NLR) vs C-reactive protein (CRP) as early predictors of AL in CRS.
A retrospectively analyzed consecutive patients who underwent a colorectal surgery with anastomosis from June 2015 to April 2019. Receiver-operating characteristic (ROC) curves were used to find the cutoff points with the best diagnostic performance of AL.
A total of 116 patients were included. From 43 patients (37%) who developed a total of 63 complications, 9 (7.76%) presented with an AL with a median of 8 days (range: 5-9). No significant differences were found for NLR between patients with vs without AL. In contrast, median CRP was significantly higher in patients who subsequently presented with AL, both on day 4 (164 vs 64, p = 0.04) and 5 (94 vs 44, p < 0.001) after surgery. The best predictive performance through ROC curves was found on postoperative day 5, with a CRP value of >54 mg/dL (AUC: 0.81, Sensitivity: 89%, Specificity: 61%).
CRP appears superior to NLR as an early predictor of AL following CRS. The best diagnostic performance was obtained on postoperative day 5 with a cutoff value of >54 mg/dL.
结直肠手术（CRS）的发病率较高，吻合口漏（AL）是最严重的并发症之一，发生率高达15%，在这些手术中占死亡率的三分之一。识别临床前标志物可能有助于早期诊断和及时干预。本研究的目的是比较中性粒细胞与淋巴细胞比值（NLR）和C反应蛋白（CRP）作为CRS中AL早期预测指标的性能。
回顾性分析2015年6月至2019年4月期间接受结直肠吻合手术的连续患者。采用受试者操作特征（ROC）曲线来确定对AL具有最佳诊断性能的截断点。
共纳入116例患者。在43例（37%）发生共63种并发症的患者中，9例（7.76%）出现AL，中位时间为8天（范围：5 - 9天）。发生AL与未发生AL的患者之间，NLR无显著差异。相比之下，随后发生AL的患者术后第4天（164 vs 64，p = 0.04）和第5天（94 vs 44，p < 0.001）的CRP中位数显著更高。通过ROC曲线发现术后第5天预测性能最佳，CRP值>54 mg/dL（AUC：0.81，敏感性：89%，特异性：61%）。
CRP作为CRS后AL的早期预测指标似乎优于NLR。术后第5天诊断性能最佳，截断值>54 mg/dL。
