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Woodford EP, Woodford HM, Hort AR, Pang TC, Lam VWT, Nahm CB. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio use in detecting bowel ischaemia in adhesional small bowel obstruction. ANZ J Surg 2022; 92:2915-2920. [PMID: 36197308 DOI: 10.1111/ans.18073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bowel ischaemia significantly increases morbidity and mortality from adhesional small bowel obstruction. Current biomarkers and clinical parameters have poor predictive value for ischaemia. Our study investigated whether neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) could be used to predict bowel ischaemia in adhesional small bowel obstruction. METHODS This single-centre retrospective study collected clinical, biochemical and radiological data from patients with adhesional small bowel obstruction between 2017 and 2020 who underwent operative management. The presence or absence of bowel ischaemia/infarction was used to distinguish two populations. Biochemical markers on admission and immediately prior to operation were collected to give platelet-lymphocyte ratio (PLR0 and PLRPRE-OP , respectively) and neutrophil-lymphocyte ratio (NLR0 and NLRPRE-OP , respectively). SAS 9.4 (SAS Institute Inc., Cary, NC) software was used for data analysis with Mann-Whitney U testing for continuous variables and Pearson Chi-square test for categorical variables. Sensitivity and specificity for PLR and NLR were calculated by means of receiver operating characteristic (ROC) curve analysis. RESULTS Twenty-seven patients had intra-operative bowel ischaemia whilst the remaining 73 had no evidence of bowel ischaemia. Both median PLRPRE-OP and NLRPRE-OP were significantly higher in patients with bowel ischaemia compared to those without (PLRPRE-OP 272 [IQR 224-433] and 231 [IQR 146-295] respectively, P = 0.027; NLRPRE-OP 12.5 [IQR 8.6-21.3] v. 5.5 [IQR 3.5-10.2] respectively, P ≤ 0.001). Area under the receiver operator characteristic curve (AUC) was 0.762 for NLRPRE-OP , with a sensitivity of 85.1% and specificity of 63% for NLR 7.4. CONCLUSION Raised NLR is predictive of bowel ischaemia in patients with adhesional small bowel obstruction.
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Affiliation(s)
| | - Hannah Mercy Woodford
- Department of Radiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Amy Rose Hort
- Acute Surgical Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tony Chun Pang
- Acute Surgical Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Vincent Wai To Lam
- Acute Surgical Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Macquarie Medical School, Macquarie University, Sydney, New South Wales, Australia
| | - Christopher Bahdah Nahm
- Acute Surgical Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Western Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
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