Kovoor Joshua G, Bacchi Stephen, Nathin Kayla, Aujayeb Nidhi, Lu Amy, Mishra Neel C, Tyagi Daksh, Stretton Brandon, Gupta Aashray K, Hugh Thomas J, Maddern Guy J
Ballarat Base Hospital, Ballarat, Victoria, Australia.
University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2025 Jul-Aug;95(7-8):1439-1445. doi: 10.1111/ans.70115. Epub 2025 Apr 3.
The relationship between postoperative in-hospital mortality and inflammatory markers has not been well described. This study aimed to characterize the association between specific clinical markers of inflammation and in-hospital mortality in the early postoperative period in general surgical patients.
This study included consecutive general surgery admissions at two tertiary hospitals in South Australia over a 2-year period. Collected data included patient demographics, Charlson comorbidity index, in-hospital mortality, vital signs, and laboratory tests. In particular, temperature, neutrophil count, lymphocyte count, platelet count, albumin level, and C-reactive protein (CRP) were collected for the 48 h after surgery. Multivariable logistic regression was conducted to examine the association between clinical inflammatory markers and in-hospital mortality in the first 24 h postoperatively and 24-48 h postoperatively.
5493 patients were included, with an average age of 52.8 (SD 19.4). 2548 (46.4%) were female, and 53 (1.0%) experienced in-hospital mortality. In the first 24 h postoperatively, temperature >38°C, neutrophil count >14 × 10/L, and a lymphocyte count >5 × 10/L were significantly associated with an increased likelihood of in-hospital mortality, whereas platelets, albumin, and CRP during were not. Between 24 and 48 h postoperatively, increases in maximum neutrophil counts, lymphocyte counts, and platelet counts were significantly associated with an increased likelihood of in-hospital mortality, whereas changes in temperature, albumin, and CRP were not.
This is the first study to characterize the inflammatory response using specific clinical laboratory markers, and their relative association with in-hospital mortality, in the first 2 days after general surgery.
术后院内死亡率与炎症标志物之间的关系尚未得到充分描述。本研究旨在明确普通外科患者术后早期特定炎症临床标志物与院内死亡率之间的关联。
本研究纳入了南澳大利亚两家三级医院连续两年的普通外科住院患者。收集的数据包括患者人口统计学信息、查尔森合并症指数、院内死亡率、生命体征和实验室检查结果。特别收集了术后48小时内的体温、中性粒细胞计数、淋巴细胞计数、血小板计数、白蛋白水平和C反应蛋白（CRP）。采用多变量逻辑回归分析，以检验术后24小时内及术后24 - 48小时临床炎症标志物与院内死亡率之间的关联。
共纳入5493例患者，平均年龄52.8岁（标准差19.4）。其中2548例（46.4%）为女性，53例（1.0%）发生院内死亡。术后24小时内，体温>38°C、中性粒细胞计数>14×10⁹/L和淋巴细胞计数>5×10⁹/L与院内死亡可能性增加显著相关，而血小板、白蛋白和CRP在此期间则无此关联。术后24至48小时，中性粒细胞计数、淋巴细胞计数和血小板计数的最大值增加与院内死亡可能性增加显著相关，而体温、白蛋白和CRP的变化则无此关联。
这是第一项利用特定临床实验室标志物描述普通外科术后前两天炎症反应及其与院内死亡率相对关联的研究。
