Role of neutrophil-to-lymphocyte ratio in the prediction of early postoperative complications after surgery for intestinal obstruction

Background
Gastrointestinal surgery is associated with significant risk of postoperative complications, reaching up to 50% of cases especially in major operations. These complications have their detrimental effects not only on the patients, physically and psychologically, but also they induce a significant increase in costs, a timely concern while healthcare expenditures need to be controlled.
Aim
This study was designed to determine the value of a simple noninvasive parameter − the neutrophil-to-lymphocyte ratio (NLR) − in the first day postoperative in the prediction of early postoperative complications following intestinal obstruction surgery.
Patients and methods
This study includes 170 consecutive patients complaining of intestinal obstruction due to different primary causes and not having a previous abdominal surgery. The number of the male patients in the study is 97 (57.1%) patients, while the females are 73 (42.9%). The age of the patients was in the range in between 16 and 70 years with a mean age of 53.16±2.57 years.
Results
The NLR value in the preoperative investigation ranges between 2 and 25 with an average value of 6.71±8.7. The NLR that was done in the first postoperative day ranges between 0.6 and 31.3 with an average value of 6.77±4.75. Although the NLR increases postoperatively, it was found that there is insignificant difference between the NLR before and after 24 h postoperatively. The NLR of the complicated patients ranged between 1.61 and 31.3 with an average value of 8.65±4.83, while that of noncomplicated cases have a range of 0.6–7.63 with an average of 3.985±1.47. The difference of the mean of NLR in first postoperative day between complicated and noncomplicated cases is highly significant. Receiver-operating characteristic curve analysis of NLR suggested that a cutoff value of 5.01 was the optimal value for predicting complications, with an area under the curve of 0.873. This cutoff point produced a sensitivity of 84.61% (95% confidence interval=0.7545–0.9133) and a specificity of 78.37% (95% confidence interval=0.6728–0.8711). The overall model quality is good as it is equal to 0.82.
Conclusion
NLR is a good, cheap, and easily available investigation that can predict postoperative early complication after operation for intestinal obstruction. It has good sensitivity and specificity in the prediction of early postoperative complications. Further studies that compare other cheap and easily available biomarkers with NLR in predicting postoperative complications are required.