C-Reactive Protein-Lymphocyte Ratio Identifies Patients at Low Risk for Major Morbidity after Oesophagogastric Resection for Cancer

Abstract

<b><i>Introduction:</i></b> Complications following oesophagogastric surgery have significant implications for patient recovery. <b><i>Objective:</i></b> identify cost-effective biomarkers which can predict morbidity. <b><i>Methods:</i></b> Analysis of all upper gastrointestinal resections in Galway University Hospital from 2014 to 2018 was performed. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and CRP-lymphocyte ratio (CLR) to predict morbidity, including anastomotic leak (AL), was assessed and compared. <b><i>Results:</i></b> Seventy-one oesophagectomies and 77 gastrectomies were performed. There were 2 (1%) 30-day mortalities and 83 (56%) morbidities of which 30 (20%) were of Clavien-Dindo grade 3 or higher. The rate of major morbidity within the oesophagectomy cohort was 27% and was 14% in the gastrectomy cohort. There were 11 (7%) ALs, 7 in the oesophagectomy cohort, and 4 in the gastrectomy cohort. From post-operative day (POD) 2 onwards, CRP could predict AL (POD2 AUC = 0.705, <i>p =</i> 0.025; POD3 AUC = 0.757, <i>p</i> = 0.005, POD4 AUC = 0.811, <i>p</i> = 0.001; and POD5 AUC = 0.824, <i>p</i> = 0.001). CLR predicted AL on POD2 onwards (POD2 AUC = 0.722, <i>p</i> = 0.005; POD3 AUC = 0.736, <i>p =</i> 0.01; POD4 AUC = 0.775, <i>p</i> = 0.003; and POD5 AUC = 0.817, <i>p</i> = 0.001). CRP level of 218 mg/dL and CLR level of 301 at POD 2 generated negative predictive values of 97 and 98%, respectively, for AL. Post-operative NLR did not display sufficient discriminatory ability for the outcomes. <b><i>Conclusion:</i></b> CRP and CLR are reliable negative predictors of major morbidity, including AL, after oesophagogastric resection. Their use can inform patient intervention and recovery.

Inflammatory Indexes for Assessing the Severity and Disease Progression of Ulcerative Colitis: A Single-Center Retrospective Study

“…Platelet counts in peripheral blood are markedly increased in patients with active UC compared with inactive UC (45), but not correlated with the Ulcerative Colitis Colonoscopic Index of Severity, which has an excellent overall assessment of endoscopic severity (46). C-reactive protein-to-lymphocyte ratio (CLR) was originally developed as a novel index to predict the major morbidity after esophagogastric cancer resection (27). To our knowledge, only Con et al explored the role of CLR for assessing the dynamic response to infliximab salvage treatment and predicting the risk of subsequent colectomy in patients with UC (47).…”

“…CAR was calculated as the CRP levels (mg/L) divided by the albumin levels (g/L) ( 26 ). CLR was calculated as the CRP levels (mg/L) divided by the lymphocyte counts (10 9 /L) ( 27 ).…”

“…Erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) are two traditional serologic biomarkers and are usually used for monitoring the disease course of UC, but their sensitivity and specificity are unsatisfactory ( 20 ). Recently, several integrated indexes have been used for the assessment of infective, acute, and critical diseases, including neutrophil-to-lymphocyte ratio (NLR) ( 21 ), platelet-to-lymphocyte ratio (PLR) ( 22 ), systemic immune-inflammation index (SII) ( 23 ), neutrophil-to-platelet ratio (NPR) ( 24 ), platelet-to-albumin ratio (PAR) ( 25 ), CRP-to-albumin ratio (CAR) ( 26 ), and CRP-to-lymphocyte ratio (CLR) ( 27 ). Notably, they are non-invasive and easier to use at a low cost.…”

Combined Detection of Peripheral Blood VEGF and Inflammation Biomarkers to Evaluate The Clinical Response and Prognostic Prediction of Non-Operative ESCC

“…Yoshinaga Okugawa MD et al 14 proposed that CLR can be used as an effective marker for perioperative and postoperative management of patients with colorectal cancer. A study of esophageal cancer showed that a high preoperative CLR was signi cantly associated with clinicopathological factors for disease development and CLR can be a more reliable biomarker of a poor outcome than other combinations of in ammation biomarkers 35 . Although our research believes that CLR is not a predictor of PFS, but the level of CLR at the end of radiotherapy is an independent predictor of the clinical response of ESCC patients, which further expands the scope of CLR application.…”

Combined detection of peripheral blood VEGF and inflammation biomarkers to evaluate the clinical response and prognostic prediction of non-operative ESCC

“…Okugawa et al 14 proposed that CLR can be used as an effective marker for perioperative and postoperative management of patients with colorectal cancer. A study of esophageal cancer showed that a high preoperative CLR was significantly associated with clinicopathological factors for disease development and CLR can be a more reliable biomarker of a poor outcome than other combinations of inflammation biomarkers 35 . Although our research believes that CLR is not a predictor of PFS, but the level of CLR at the end of radiotherapy is an independent predictor of the clinical response of ESCC patients, which further expands the scope of CLR application.…”