Prognostic value of preoperative neutrophil-to-lymphocyte ratio in Crohn’s disease

Abstract

SummaryBackgroundThe Neutrophil-to-lymphocyte-ratio has recently gained increased attention as a prognostic marker for malignant disease and short term outcomes. There is little data available in patients with Crohn’s disease, thus the present study was conducted to correlate preoperative Neutrophil-to-lymphocyte-ratio values with disease phenotype and postoperative course.MethodsWe comprised 373 patients, who underwent intestinal resection for symptomatic Crohn’s disease at an academic tertiary referral centre between 2000 and 2014. Preoperative Neutrophil-to-lymphocyte-ratio values were calculated and analyzed in regard to disease phenotype and 30-day morbidity rate. All relevant data were obtained from the institutional database and individual chart review.ResultsMale patients had significantly higher preoperative Neutrophil-to-lymphocyte-ratio values compared to female patients (5 vs. 4; p = 0.0075). A higher Neutrophil-to-lymphocyte-ratio was also found in patients with an acute indication for surgery (6.15 vs. 4.3; p = 0.0374), presenting with abscesses (5.36 vs. 4.28; p = 0.0254), inflammatory masses (5.23 vs. 4.08; p = 0.0294) or malignancy in the resected specimen (9.06 vs. 4.35, p = 0.0231). Surprisingly, patients developing postsurgical complications showed significantly lower Neutrophil-to-lymphocyte-ratio values (3.77 vs. 4.67; p = 0.0461).ConclusionsElevated preoperative Neutrophil-to-lymphocyte-ratio in symptomatic Crohn’s disease is not predictive for complications. However, Neutrophil-to-lymphocyte-ratio showed a significant correlation with specific disease phenotypes. Most strikingly, Neutrophil-to-lymphocyte-ratio was highly elevated in patients with a colorectal cancer in the resected specimen, which needs to be addressed in future studies.

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

“…Eleven studies employed NLR as a potential tool to predict post-surgical hospital stay or development of various complications in CD [ 84 , 98 , 99 , 100 , 101 ], UC [ 93 , 102 , 103 , 104 , 105 ], or IBD [ 106 , 107 ].…”

“…Kang et al [ 84 ] generated a cutpoint of 4.1 and found NLR predicted risk of postoperative complications with 70% sensitivity and 56.4% specificity (OR 2.782, 95% CI 1.042–7.425, p = 0.041), primarily respiratory infection ( p = 0.046). However, in patients who underwent intestinal resection for symptomatic CD, Argeny et al [ 99 ] found preoperative NLR values were lower in patients who experienced post-surgical complications (r s = 0.1041, p = 0.0446). Conversely, Argeny et al [ 99 ] also determined that NLR values were higher in patients with acute indication for surgery ( p = 0.037), in those presenting with abscesses ( p = 0.025), those with inflammatory masses ( p = 0.029), and those with malignancy in resected specimens ( p = 0.023).…”

“…However, in patients who underwent intestinal resection for symptomatic CD, Argeny et al [ 99 ] found preoperative NLR values were lower in patients who experienced post-surgical complications (r s = 0.1041, p = 0.0446). Conversely, Argeny et al [ 99 ] also determined that NLR values were higher in patients with acute indication for surgery ( p = 0.037), in those presenting with abscesses ( p = 0.025), those with inflammatory masses ( p = 0.029), and those with malignancy in resected specimens ( p = 0.023). On the other hand, Argeny et al [ 99 ] did not note a difference in NLR values between those with stenosis ( p = 0.134) or fistula ( p = 0.153).…”

Neutrophil to Lymphocyte Ratio as a Predictor of Long-Term Outcome in Peritoneal Dialysis Patients: A 5-Year Cohort Study

“…Therefore, elevated NLR should be more predictive than either of the two parameters. In recent years, NLR was reported as a sensitive systemic inflammation marker and associated with adverse outcome in diabetic nephropathy [14], CVD [15, 16], inflammatory bowel disease [17], pulmonary arterial hypertension [18], colon and pancreas cancer [19], and so on.…”

Association of Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratio with Adverse Events in Endovascular Repair for Abdominal Aortic Aneurysm

“…The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been increasingly recognized as biomarkers of systemic inflammation [ 9 ]. Moreover, they could predict the outcome in patients suffering from a variety of conditions, including major abdominal and cardiac surgery and percutaneous coronary intervention [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Recently, the role of NLR and PLR has been investigated in vascular surgery with limited data existing regarding their role in the early postoperative period [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”