The neutrophil‐to‐lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery

Josse, Jonathan M.; Cleghorn, Michelle C.; Ramji, Karim; Jiang, Haiyan; Elnahas, Ahmad; Jackson, Timothy; Okrainec, Allan; Quereshy, Fayez A.

doi:10.1111/codi.13373

Cited by 83 publications

(66 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The cut-off level for prediction of post-operative complications was found to be 5.5 [21]. However, another study found that a pre-operative NLR value of ≥ 2.3 was associated with major post-operative complications in patients undergoing colorectal surgeries [22]. The baseline NLR in the present study was a little higher than that of the mentioned studies.…”

Section: Discussioncontrasting

confidence: 75%

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries

Surhonne

Hebri

Kannan

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

Neutrophil to lymphocyte ratio (NLR) is a simple marker in peripheral blood and is used to assess inflammatory response and physiological stress during the peri-operative period. Anesthetic technique may influence NLR, thereby modulating the inflammatory response and surgical outcomes. The study aimed to evaluate the relationship between blood NLR and anesthetic techniques in patients undergoing infraumbilical surgeries. Methods: Institutional ethical committee approval and patient consent were obtained. A prospective randomized double-blinded study was conducted between July 2017 and November 2017, involving 80 patients classified as the American Society of Anesthesiologists grade 1 and 2, aged 18-60 years, and scheduled for elective infraumbilical surgeries. Unwilling and those with infections were excluded. The patients were randomly divided into two groups: Group G (general anesthesia) and Group S (spinal anesthesia) as per the standardized protocol. Differential counts of leukocytes and NLR in the peripheral blood were obtained pre-operatively on the morning of surgery and at 2 h and 24 h after surgery in both the groups. The data were analyzed using appropriate statistical tests. Results: The demographic parameters, basal total leukocyte count (TLC), and NLR were comparable between the groups. TLC and NLR were significantly higher in Group G as compared to that in Group S post-operatively. The post-operative rise in TLC and NLR from the basal values was significantly higher in Group G as compared to that in Group S. Conclusions: General anesthesia was associated with a greater increase in TLC and NLR when compared with spinal anesthesia.

show abstract

Section: Discussioncontrasting

confidence: 75%

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries

Surhonne

Hebri

Kannan

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Finally, our study showed that preoperative inflammation was associated with a longer postoperative LOS. This is consistent with previous studies, which showed that elevated NLR predicted perioperative complications and was associated with increased LOS for patients undergoing resection for CRC [15,30]. This finding has profound implications for patient care and highlights the usefulness of a simple, inexpensive biomarker that correlates the inflammatory state with colon cancer to its impact on hospitalisation.…”

Section: Discussionsupporting

confidence: 91%

“…Similarly, systemic inflammation has also been suggested to play an essential role in cancer progression and has been reported to be an indicator of poor prognosis in several malignancies [3]. Pre-treatment values of neutrophil-to-lymphocyte ratio (NLR) is one standard measure of systemic inflammation and have been suggested to predict surgical complications and survival [15,16]. Since measures of body composition and systemic inflammation can be evaluated with existing clinical data, they may become new indicators to identify patients with poorer prognosis.…”

Section: Introductionmentioning

confidence: 99%

Significance of Body Composition and Systemic Inflammation in Patients with Operable Colon Cancer Treated with Curative Intent

Hong¹,

Rouse²,

Moore³

et al. 2019

ACO

View full text Add to dashboard Cite

Background: Muscle abnormalities and systemic inflammation have been associated with cancer progression and poor disease outcomes in patients with colon cancer. These factors are easily evaluated and can potentially be modified to improve outcomes. The objective of this study is to investigate the relationship between computed tomography (CT) derived measures of body composition, including low muscle mass (sarcopenia) and low muscle radiodensity (myosteatosis). It will also examine their association with systemic inflammation and determine whether these factors impact hospital length of stay for patients undergoing resection of their primary colorectal cancer. Methods: This study included 133 patients with stage I to III colon cancers diagnosed from 2011 through 2018 who underwent resection with curative intent. CT scans were used to identify sarcopenia and myosteatosis using predefined sex-specific and body mass index (BMI)-specific thresholds. The primary measure for systemic inflammation was the neutrophil-to-lymphocyte ratio. Tumour and patient characteristics were recorded. The primary outcome was hospital length of stay. Associations between body composition and systemic inflammation were examined using linear regression analyses, and their relationship with post-surgical length of stay was determined using logistic regression analyses. Results: A significant proportion of patients were overweight or obese (60.9%). Sarcopenia and myosteatosis were highly prevalent (41.4% and 39.1% respectively). Muscle mass and muscle radiodensity were not significantly correlated with each other. Male sex (p < 0.001) and higher BMI (p < 0.001) were associated with greater muscle mass. Male sex (p = 0.020) was also associated with greater muscle radiodensity but higher BMI (p < 0.001) was associated with lower muscle radiodensity. Inflammation was present in 39.1% of patients. Elevated neutrophil-to-lymphocyte ratio was associated with longer length of stay (OR 1.29, 95% CI 1.04-1.61, p = 0.019). Conclusion: Sarcopenia and myosteatosis were prevalent among colon cancer patients, despite many of them being overweight or obese. Systemic inflammation was associated with prolonged length of stay post-surgery and could potentially be utilised to delineate patients with poorer recovery and who may benefit from additional monitoring or interventions to reduce the length of hospitalisation. These commonly collected markers could enhance prognostication and identify patients with a poorer outcome.

show abstract

“…A high PLR level is reported to be associated with reduced OS and decreased time to recurrence in colorectal cancer patients [29]. It has also been reported that NLR is closely correlated with postoperative complications and prognosis [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

et al. 2016

View full text Add to dashboard Cite

Background/AimsAdjuvant chemotherapy (AC) has been reported to improve the prognosis for patients with Stage III colorectal cancer (CRC). However, some patients experience severe side effects and must stop AC. The C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammation-based score that could reflect the patient’s general condition. The aim of this study was to evaluate the predictive value of the CAR for side effects of AC in CRC.MethodsA total of 136 CRC patients who received AC were retrospectively analyzed. The patients were subdivided into two groups by the CAR level (CAR ≥0.1, n = 30; CD < 0.1, n = 106).ResultsThe presence of lymphatic invasion, severe side effects, and discontinuation of AC were associated with high CAR levels (p = 0.02, <0.01, and 0.02; respectively). High levels of the Glasgow Prognostic Score (GPS) and the neutrophil to lymphocyte ratio (NLR) appeared to be associated with the CAR (p = 0.04, p<0.01; respectively). Multivariate analysis identified CAR≥0.1 (HR: 7.06, 95% CI: 2.51–19.88, p<0.01) as a significant determinant of severe side effects of AC. CAR had the highest area under the curve (0.79) among several inflammation-based scores.ConclusionThe present study showed that the CAR is a novel and promising inflammation-based score for ≥ grade 3 side effects of AC in node-positive CRC.

show abstract

The neutrophil‐to‐lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery

Abstract: Preoperative NLR ≥ 2.3 may be a risk factor for major surgical complications following colorectal resection. Further study is needed to validate this threshold and evaluate the clinical implications of these findings.

Cited by 83 publications

References 19 publications

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries

The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries

Significance of Body Composition and Systemic Inflammation in Patients with Operable Colon Cancer Treated with Curative Intent

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

Contact Info

Product

Resources

About