Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients—The Case of Neutrophil-to-Lymphocyte Ratio
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Definition of Anastomosis Dehiscence/Leakage
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Patients
3.2. Neutrophil Counts
3.3. Lymphocyte Counts
3.4. NLR Counts
3.5. The Receiver Operating Characteristic Curve (ROC) Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Non-L Group | L Group | p-Value | |
---|---|---|---|
number of patients | 217 | 28 | |
age, years (mean ± SD) | 74.7 ± 12.4 | 74.6 ± 12.0 | 0.719 |
gender (M:F) | 131:86 | 20:8 | 0.257 |
type of cancer | <0.001 | ||
colon n = 123 | 119 | 4 | |
rectal n = 122 | 98 | 24 | |
resection type n (%) | 0.002 | ||
right-sided hemicolectomy | 61 (28.1) | 3 (10.7) | |
left-sided hemicolectomy | 21(9.7) | 0 (0.0) | |
sigmoid colon resection | 37 (17.0) | 1 (3.6) | |
low anterior rectal resection | 98 (45.2) | 24 (85.7) | |
protective ostomy n (%) | 45 (20.7) | 10 (35.7) | 0.020 |
hospitalization (days, mean ± SD) | 7.4 ± 2.1 | 23.8 ± 14.6 | <0.001 |
Day | Non-L Group | L Group | p-Value |
---|---|---|---|
0 | 5.04 (1.91) | 5.33 (2.13) | 0.501 |
1 | 9.16 (3.20) | 6.07 (2.98) | <0.001 |
2 | 9.29 (4.05) | 8.62 (4.60) | 0.411 |
3 | 8.59 (4.34) | 8.63 (4.83) | 0.817 |
4 | 7.48 (4.14) | 9.34 (5.83) | 0.158 |
5 | 6.34 (3.13) | 9.14 (6.65) | 0.123 |
6 | 6.10 (2.89) | 8.65 (6.10) | 0.103 |
7 | 5.55 (2.30) | 8.18 (6.11) | 0.125 |
Day | Non-L Group | L Group | p-Value |
---|---|---|---|
0 | 1.46 (0.73) | 1.25 (0.45) | 0.234 |
1 | 1.03 (0.38) | 1.15 (0.60) | 0.359 |
2 | 1.14 (0.85) | 0.94 (0.42) | 0.225 |
3 | 1.13 (0.88) | 0.84 (0.55) | 0.008 |
4 | 1.13 (0.61) | 0.91 (0.52) | 0.040 |
5 | 1.20 (0.73) | 0.94 (0.51) | 0.041 |
6 | 1.32 (0.86) | 1.09 (0.52) | 0.130 |
7 | 1.37 (0.64) | 1.27 (0.57) | 0.594 |
Day | Non-L Group | L Group | p-Value |
---|---|---|---|
0 | 4.88 (4.72) | 4.81 (2.96) | 0.193 |
1 | 9.37 (2.98) | 5.50 (1.54) | <0.001 |
2 | 10.49 (7.35) | 9.46 (4.46) | 0.736 |
3 | 9.59 (6.13) | 11.69 (5.72) | 0.023 |
4 | 8.08 (6.02) | 10.89 (5.16) | 0.001 |
5 | 6.81 (5.64) | 10.44 (5.40) | <0.001 |
6 | 6.16 (6.41) | 9.01 (5.55) | 0.001 |
7 | 5.04 (3.84) | 7.01 (4.61) | 0.010 |
Day | AUC | Lower Bound | Upper Bound | p-Value |
---|---|---|---|---|
0 | 0.576 | 0.483 | 0.668 | 0.193 |
1 | 0.881 | 0.829 | 0.934 | <0.001 |
2 | 0.480 | 0.369 | 0.592 | 0.736 |
3 | 0.632 | 0.521 | 0.743 | 0.023 |
4 | 0.698 | 0.606 | 0.791 | 0.001 |
5 | 0.732 | 0.639 | 0.824 | <0.001 |
6 | 0.686 | 0.575 | 0.796 | 0.001 |
7 | 0.649 | 0.537 | 0.762 | 0.010 |
Day | Cut-Off | AUC | 95% CI | p | Se (%) | Sp (%) | PPV (%) | NPV (%) |
---|---|---|---|---|---|---|---|---|
0 | - | 0.576 | 0.483–0.668 | 0.193 | - | - | - | - |
1 | 7.40 | 0.881 | 0.829–0.934 | <0.001 | 68.7 | 96.4 | 28.4 | 99.3 |
2 | - | 0.480 | 0.369–0.592 | 0.736 | - | - | - | - |
3 | 11.90 | 0.632 | 0.521–0.743 | 0.023 | 50.0 | 76.0 | 21.2 | 92.2 |
4 | 6.50 | 0.698 | 0.606–0.791 | 0.001 | 82.1 | 51.6 | 17.6 | 95.6 |
5 | 5.60 | 0.732 | 0.639–0.824 | <0.001 | 82.1 | 52.5 | 18.3 | 95.8 |
6 | 6.50 | 0.686 | 0.575–0.796 | 0.001 | 64.3 | 70.5 | 21.9 | 93.9 |
7 | 3.50 | 0.649 | 0.537–0.762 | 0.010 | 85.7 | 41.5 | 15.3 | 94.7 |
Day | NLR Cut-Off | Patients (n) | Leaks n, (%) | No Leaks n, (%) | Positive Likelihood Ratio (95% CI) |
---|---|---|---|---|---|
1 | ≥7.40 | 150 | 1 (0.7) | 149 (99.3) | 3.08 (2.50–3.79) |
3 | ≥11.90 | 66 | 14 (21.2) | 52 (78.8) | 2.09 (1.34–3.24) |
4 | ≥6.50 | 131 | 23 (17.6) | 108 (82.4) | 1.65 (1.33–2.05) |
5 | ≥5.60 | 126 | 23 (18.3) | 103 (81.7) | 1.73 (1.39–2.16) |
6 | ≥6.50 | 82 | 18 (22.0) | 64 (78.0) | 2.18 (1.54–3.08) |
7 | ≥3.50 | 150 | 23 (15.3) | 127 (84.7) | 1.40 (1.14–1.72) |
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Ioannidis, A.; Tzikos, G.; Smprini, A.; Menni, A.-E.; Shrewsbury, A.; Stavrou, G.; Paramythiotis, D.; Michalopoulos, A.; Kotzampassi, K. Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients—The Case of Neutrophil-to-Lymphocyte Ratio. Diagnostics 2024, 14, 1806. https://doi.org/10.3390/diagnostics14161806
Ioannidis A, Tzikos G, Smprini A, Menni A-E, Shrewsbury A, Stavrou G, Paramythiotis D, Michalopoulos A, Kotzampassi K. Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients—The Case of Neutrophil-to-Lymphocyte Ratio. Diagnostics. 2024; 14(16):1806. https://doi.org/10.3390/diagnostics14161806
Chicago/Turabian StyleIoannidis, Aristeidis, Georgios Tzikos, Aikaterini Smprini, Alexandra-Eleftheria Menni, Anne Shrewsbury, George Stavrou, Daniel Paramythiotis, Antonios Michalopoulos, and Katerina Kotzampassi. 2024. "Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients—The Case of Neutrophil-to-Lymphocyte Ratio" Diagnostics 14, no. 16: 1806. https://doi.org/10.3390/diagnostics14161806