Comparative Analysis of Preoperative Ratio Based Markers in Predicting Postoperative Infectious Complications After Gastrectomy

Abstract

<b>Introduction:</b> Postoperative infections (POIs) are associated with prolonged postoperative recovery, delayed adjuvant therapy, psychological problems, and poor long-term outcomes.</br></br> <b>Aim:</b> The study aims to cross-compare the ratio-based preoperative parameters to predict POIs in patients with D2 gastrectomy for gastric cancer.</br></br> <b>Materials and Methods:</b> A retrospective cohort and single-center study evaluated the data of 293 patients who underwent curative gastrectomy between January 2007 and November 2019 in a tertiary hospital in Istanbul. A receiver operating characteristic (ROC) curve was used to assess the ability of laboratory values to predict clinically relevant POIs. The predictive capacity of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRPalbumin ratio (CAR) was calculated by the area under the curve. Then, the cutoff points were determined for all 4 indexes.</br></br> <b>Results:</b> POIs developed in 77 (26.2%) patients. Patients with POI had higher Charlson Comorbidity Index (CCI) scores and a longer length of hospital stay. ROC curve analysis revealed that NLR, LMR, and CAR were significantly effective in predicting POI, while PLR was ineffective. LMR was the best ability to predict POI. According to multivariate analysis, CCI score ≥ 3, NLR > 3.8, and LMR ≤ 2.34 were independent risk factors influencing POI.</br></br> <b>Conclusion:</b> Preoperative LMR was most predictive for POI. Although CAR predicted the development of POI, it was not superior to LMR or NLR. PLR did not have any prediction for POI. In addition, increased comorbidity (CCI ≥ 3) was an independent risk factor for POI.