Ramos Diego, Gallego-Colón Enrique, Mínguez Javier, Bodega Ignacio, Priego Pablo, García-Moreno Francisca
General and Gastrointestinal Surgery Department, Hospital Central de la Defensa "Gómez Ulla" CSVE, 28047 Madrid, Spain.
Department of Medicine, Escuela Militar de Sanidad, 28047 Madrid, Spain.
Cancers (Basel). 2025 Jan 3;17(1):125. doi: 10.3390/cancers17010125.
BACKGROUND/OBJECTIVES: Anastomotic leakage (AL) is one of the most concerning complications following gastrectomy. The aim of this study was to assess and compare the predictive accuracy of C-reactive protein (CRP), procalcitonin (PCT), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), fibrinogen, and the mean platelet volume (MPV) in the early diagnosis of post-gastrectomy AL.
A prospective bicentric observational study was conducted including all patients undergoing elective gastrectomy between August 2018 and December 2022. The performance of the selected biomarkers in predicting the existence of AL within the first 7 postoperative days (PODs) was assessed.
A total of 107 patients were included for analysis. The incidence of AL was 20.56%, and the median day of diagnosis was on POD5 (interquartile range 4-6). CRP, PCT, the NLR, the PLR, and fibrinogen showed significant associations with the presence of AL (from POD2 for CRP and fibrinogen and from POD3 for PCT, NLR, and PLR). CRP demonstrated a superior predictive accuracy on POD4, with a threshold value of 181.4 mg/L (NPV 99%; AUC 0.87, < 0.001); PCT demonstrated a superior predictive accuracy on POD7, with a threshold value of 0.13 μg/L (NPV 98%; AUC 0.84, < 0.001); the NLR showed a superior predictive accuracy on POD6, with a threshold ratio of 6.77 (NPV 95%; AUC 0.86, < 0.001); the PLR achieved a superior predictive accuracy on POD7, with a ratio of 234 (NPV 98%; AUC 0.71; = 0.002); and fibrinogen demonstrated a superior predictive accuracy on POD5, with a threshold of 7.344 g/L (NPV 98%; AUC 0.74; = 0.003). In the comparison of predictive accuracy, CPR, PCT, and the NLR were found to be superior to all other biomarkers.
CRP, PCT, and the NLR are biomarkers with a sufficient predictive ability to clinically discard the presence of AL within the first postoperative week.
背景/目的：吻合口漏（AL）是胃切除术后最令人担忧的并发症之一。本研究的目的是评估和比较C反应蛋白（CRP）、降钙素原（PCT）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、纤维蛋白原和平均血小板体积（MPV）在胃切除术后AL早期诊断中的预测准确性。
进行了一项前瞻性双中心观察性研究，纳入了2018年8月至2022年12月期间所有接受择期胃切除术的患者。评估了所选生物标志物在预测术后第1个7天（POD）内AL存在情况的表现。
共纳入107例患者进行分析。AL的发生率为20.56%，诊断的中位天数为POD5（四分位间距4 - 6）。CRP、PCT、NLR、PLR和纤维蛋白原与AL的存在显著相关（CRP和纤维蛋白原从POD2起，PCT、NLR和PLR从POD3起）。CRP在POD4时显示出较高的预测准确性，阈值为181.4mg/L（阴性预测值99%；曲线下面积0.87，P<0.001）；PCT在POD7时显示出较高的预测准确性，阈值为0.13μg/L（阴性预测值98%；曲线下面积0.84，P<0.001）；NLR在POD6时显示出较高的预测准确性，阈值比值为6.77（阴性预测值95%；曲线下面积0.86，P<0.001）；PLR在POD7时显示出较高的预测准确性，比值为234（阴性预测值98%；曲线下面积0.71，P = 0.002）；纤维蛋白原在POD5时显示出较高的预测准确性，阈值为7.344g/L（阴性预测值98%；曲线下面积0.74，P = 0.003）。在预测准确性比较中，发现CPR、PCT和NLR优于所有其他生物标志物。
CRP、PCT和NLR是具有足够预测能力的生物标志物，可在术后第一周内临床上排除AL的存在。
