Comprehensive analysis of the association between inflammation indexes and complications in patients undergoing pancreaticoduodenectomy

Minghua Ma; Guo Li; Baoyong Zhou; Kaili Li; Zhongjun Wu; Lingwang Kong; Maoyun Liu; Miao Liu; Cheng Zhang; Huarong Yu; Shuaiqi Wang; Zuotian Huang; Kezhen Zong

doi:10.3389/fimmu.2023.1303283

Comprehensive analysis of the association between inflammation indexes and complications in patients undergoing pancreaticoduodenectomy

Front Immunol. 2023 Nov 23:14:1303283. doi: 10.3389/fimmu.2023.1303283. eCollection 2023.

Authors

Minghua Ma^#^{1

2}, Guo Li^#¹, Baoyong Zhou¹, Kaili Li^{1

2}, Zhongjun Wu¹, Lingwang Kong³, Maoyun Liu³, Miao Liu³, Cheng Zhang³, Huarong Yu², Shuaiqi Wang^{2

3}, Zuotian Huang^{1

2

3}, Kezhen Zong¹

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Chongqing Medical University, Chongqing, China.
³ Chongqing University Cancer Hospital, Chongqing, China.

^# Contributed equally.

Abstract

Background: During clinical practice, routine blood tests are commonly performed following pancreaticoduodenectomy (PD). However, the relationship between blood cell counts, inflammation-related indices, and postoperative complications remains unclear.

Method: We conducted a retrospective study, including patients who underwent PD from October 2018 to July 2023 at the First Hospital of Chongqing Medical University, and compared baseline characteristics and clinical outcomes among different groups. Neutrophil count (NC), platelet count (PLT), lymphocyte count (LC), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and the product of platelet count and neutrophil count (PPN) were derived from postoperative blood test results. We investigated the association between these indicators and outcomes using multivariable logistic regression and restricted cubic spline analysis. The predictive performance of these indicators was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

Result: A total of 232 patients were included in this study. Multivariate logistic regression and restricted cubic spline analysis showed that all indicators, except for PLT, were associated with clinical postoperative pancreatic fistula (POPF). SII, NLR, and NC were linked to surgical site infection (SSI), while SII, NLR, and PLR were correlated with CD3 complication. PLT levels were related to postoperative hemorrhage. SII (AUC: 0.729), NLR (AUC: 0.713), and NC (AUC: 0.706) effectively predicted clinical POPF.

Conclusion: In patients undergoing PD, postoperative inflammation-related indices and blood cell counts are associated with various complications. NLR and PLT can serve as primary indicators post-surgery for monitoring complications.

Keywords: blood routine examination; complication; inflammatory indexes; pancreaticoduodenectomy; restricted cubic splines (RCS).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Inflammation* / etiology
Lymphocyte Count
Pancreaticoduodenectomy* / adverse effects
Platelet Count
Retrospective Studies

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research is supported by Chongqing Research Performance Incentive and Guidance Project (cstc2022jxjl120032), Chongqing technology innovation and application development key project (cstc2021jscx-gksbX0060) and the Natural Science Foundation of Chongqing (CSTB2023NSCQ- BHX0131).