Can inflammatory markers such as lymphocyte to C-reactive protein ratio and hemoglobin, albumin, lymphocyte, and platelet score predict complications after loop ileostomy closure?

Yıl 2024, Cilt: 29 Sayı: 2, 224 - 232, 29.05.2024

Mevlüt Yordanagil , Hüseyin Bakır , Murat Yıldırım , Namık Özkan , İsmail Okan

https://doi.org/10.21673/anadoluklin.1421211

Öz

Aim: This study aims to investigate whether inflammatory biochemical markers such as hemoglobin, albumin, lymphocyte, platelet scores (HALP), and lymphocyte-C-reactive protein ratio (LCR) can predict complications after ileostomy closure.

Methods: Eighty-five patients who underwent loop ileostomy closure were included in this retrospective study. Alongside the patient’s demographic data, surgical data, histopathology results, and biochemistry data were recorded. Complications that occurred within the first 30 days after surgery were evaluated using the Clavien-Dindo classification. Inflammation markers such as HALP and LCR were obtained using biochemical parameters.

Results: The rate of mild complications (Clavien-Dindo I and II) was 27%, while the rate of severe complications (Clavien-Dindo III and IV) was 12.94%. A statistically significant correlation was found between the development of early complications and levels of albumin, lymphocyte, neutrophil, and C-reactive protein (CRP) (p<0.05). Patients who developed complications had lower mean serum albumin levels and higher mean neutrophil and CRP values. There was a strong correlation between HALP score and LCR and complications in patients (p<0.05).

Conclusion: It was concluded that HALP and LCR measured preoperatively could be important predictors of early complications after loop ileostomy closure.

Anahtar Kelimeler

Biochemical markers, inflammation, loop ileostomy, postoperative complications

Lenfosit/C-reaktif protein oranı ve hemoglobin, albümin, lenfosit ve trombosit skoru gibi enflamatuar belirteçler loop ileostomi kapatılması sonrası komplikasyonları öngörebilir mi?

Öz

Amaç: Bu çalışmanın amacı hemoglobin, albümin, lenfosit ve trombosit skorları (HALP) ve lenfosit-C-reaktif protein oranı (LCR) gibi inflamatuar biyokimyasal belirteçlerin ileostomi kapatılması sonrası komplikasyonları öngörüp öngöremediğini araştırmaktır.

Yöntemler: Bu retrospektif çalışmaya loop ileostomi kapatılan seksen beş hasta dahil edildi. Hastaların demografik verilerinin yanı sıra ameliyat verileri, histopatoloji sonuçları ve biyokimya verileri veritabanına kaydedildi. Ameliyattan sonraki ilk 30 gün içinde ortaya çıkan komplikasyonlar Clavien-Dindo sınıflandırması kullanılarak değerlendirildi. HALP ve LCR gibi inflamasyon belirteçleri biyokimyasal parametreler kullanılarak elde edildi.

Bulgular: Hafif komplikasyonların (Clavien-Dindo I ve II) oranı %27 iken, ciddi komplikasyonların (Clavien-Dindo III ve IV) oranı %12.94 idi. Erken komplikasyon gelişimi ile albümin, lenfosit, nötrofil ve C-reaktif protein (CRP) düzeyleri arasında istatistiksel olarak anlamlı bir korelasyon bulundu (p<0.05). Komplikasyon gelişen hastaların ortalama serum albümin düzeyleri daha düşük, ortalama nötrofil ve CRP değerleri ise daha yüksekti. HALP skoru ve LCR ile hastalardaki komplikasyonlar arasında güçlü bir korelasyon vardı (p<0.05).

Sonuç: Ameliyat öncesi ölçülen HALP ve LCR’nin loop ileostomi kapatılması sonrası erken komplikasyonların önemli belirleyicileri olabileceği sonucuna varıldı.

Anahtar Kelimeler

Ameliyat sonrası komplikasyonlar, biyokimyasal belirteçler, inflamasyon, loop ileostomi

Kaynakça

• Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis. 2003;5(5):478-82.
• D’Haeninck A, Wolthuis AM, Penninckx F, D’Hondt M, D’Hoore A. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg. 2011;111(3):136-41.
• García-Botello SA, García-Armengol J, García-Granero E, et al. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg. 2004;21(5-6):440-6.
• Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg. 2008;32(9):2101-6.
• Bain IM, Patel R, Keighley MR. Comparison of sutured and stapled closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl. 1996;78(6):555-6.
• Hasegawa H, Radley S, Morton DG, Keighley MR. Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg. 2000;231(2):202-4.
• Wong KS, Remzi FH, Gorgun E, et al. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum. 2005;48(2):243-50.
• Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149-63.
• Clarke SJ, Chua W, Moore M, et al. Use of inflammatory markers to guide cancer treatment. Clin Pharmacol Ther. 2011;90(3):475-8.
• Kahramanca S, Kaya O, Özgehan G, et al. Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier’s gangrene severity index for predicting the number of debridements in Fourner’s gangrene? Ulus Travma Acil Cerrahi Derg. 2014;20(2):107-12.
• Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer. 2001;91(12):2214-21.
• Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14(2):381-9.
• Jurasz P, Alonso-Escolano D, Radomski MW. Platelet--cancer interactions: mechanisms and pharmacology of tumour cell-induced platelet aggregation. Br J Pharmacol. 2004;143(7):819-26.
• Madani R, Day N, Kumar L, Tilney HS, Gudgeon AM. Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis. Dig Surg. 2019;36(3):183-94.
• Lord I, Reeves L, Gray A, Woodfield J, Clifford K, Thompson-Fawcett M. Loop ileostomy closure: a retrospective comparison of three techniques. ANZ J Surg. 2020;90(9):1632-6.
• Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming FJ. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis. 2013;15(4):458-62.
• Baik H, Bae KB. Low albumin level and longer interval to closure increase the early complications after ileostomy closure. Asian J Surg. 2021;44(1):352-7.
• Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82.
• Jiang H, Li H, Li A, et al. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget. 2016;7(44):72076-83.
• Schneider V, Lee LD, Stroux A, et al. Risk factors for reoperation after ileostomy reversal - Results from a prospective cohort study. Int J Surg. 2016;36(Pt A):233-9.
• Yamamoto M, Saito H, Uejima C, et al. Combined Pre- and Postoperative Lymphocyte Count Accurately Predicts Outcomes of Patients with Colorectal Cancer. Dig Surg. 2019;36(6):487-94.
• Tatara T, Suzuki S, Kanaji S, Yamamoto M, Matsuda Y, Hasegawa H et al. Lymphopenia predicts poor prognosis in older gastric cancer patients after curative gastrectomy. Geriatr Gerontol Int. 2019;19(12):1215-9.
• Lodwick DL, Cooper JN, Kenney B, Deans KJ, Minneci PC, Thakkar RK. Lymphocyte depression as a predictor of postoperative intraabdominal abscess after appendectomy in children. J Pediatr Surg. 2017;52(1):93-7.
• Mohamud M, Osborne L, Jones HG, et al. Thrombocytosis as a Marker for Postoperative Complications in Colorectal Surgery. Gastroenterol Res Pract. 2018;2018:1978639.
• Okugawa Y, Toiyama Y, Yamamoto A, et al. Lymphocyte-C-reactive Protein Ratio as Promising New Marker for Predicting Surgical and Oncological Outcomes in Colorectal Cancer. Ann Surg. 2020;272(2):342-51.
• Okugawa Y, Toiyama Y, Yamamoto A, et al. Lymphocyte-to-C-reactive protein ratio and score are clinically feasible nutrition-inflammation markers of outcome in patients with gastric cancer. Clin Nutr. 2020;39(4):1209-17.
• Yildirim M, Dasiran F, Angin YS, Okan I. Lymphocyte-C-reactive protein ratio: a putative predictive factor for intestinal ischemia in strangulated abdominal wall hernias. Hernia. 2021;25(3):733-9.