Neutrophil-to-lymphocyte ratio for predicting postoperative recurrence in Crohn's disease patients with isolated anastomotic lesions

Rirong Chen; Chao Li; Kang Chao; Yizhe Tie; Jieqi Zheng; Huili Guo; Zhirong Zeng; Li Li; Minhu Chen; Shenghong Zhang

doi:10.1177/17562848231165129

Neutrophil-to-lymphocyte ratio for predicting postoperative recurrence in Crohn's disease patients with isolated anastomotic lesions

Therap Adv Gastroenterol. 2023 Mar 31:16:17562848231165129. doi: 10.1177/17562848231165129. eCollection 2023.

Authors

Rirong Chen¹, Chao Li^{1

2}, Kang Chao³, Yizhe Tie^{1

2}, Jieqi Zheng^{1

2}, Huili Guo³, Zhirong Zeng¹, Li Li⁴, Minhu Chen⁴, Shenghong Zhang⁴

Affiliations

¹ Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
² Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
³ Division of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁴ Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, China.

Abstract

Background: Patients with isolated anastomotic lesions (iAL) are common in postoperative Crohn's disease (CD) and have heterogeneous prognosis.

Objectives: To investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in CD patients with iAL.

Design: A bicenter retrospective cohort study.

Methods: CD patients who received ileocolonic resection from 2013 and 2020 and had a modified Rutgeerts score of i2a were recruited. NLR was determined within 1 week around the initial endoscopy after ileocolectomy. The primary outcome was clinical recurrence. Kaplan-Meier method and Cox hazard regression analysis were utilized to assess the association between candidate variables and outcomes of interest.

Results: In total, 411 postoperative CD patients were preliminarily reviewed and 83 patients were eligible. In total, 36 (48.6%) patients experienced clinical recurrence with a median follow-up time of 16.3 (interquartile range, 9.7-26.3) months. NLR > 2.45 and age at surgery >45 years had higher cumulative incidence of clinical recurrence in the Kaplan-Meier analysis. After adjusted for potential confounders, NLR > 2.45 was the only independent risk factor for clinical recurrence, with an adjusted hazard ratio (HR) of 2.88 [95% confidence interval (CI), 1.39-6.00; p = 0.005]. Furthermore, a risk score based on NLR and age at surgery were built to further stratify patients. Compared to those who scored 0, patients with a score of 1 and 2 had an adjusted HR of 2.48 (95% CI, 1.22-5.02) and 6.97 (95% CI, 2.19-22.16) for developing clinical recurrence, respectively.

Conclusions: NLR is a promising prognostic biomarker for CD patients with iAL. The utilization of NLR and the risk score to stratify patients may facilitate the personalized management in patients with iAL.

Keywords: Crohn’s disease; isolated anastomotic lesions; neutrophil-to-lymphocyte ratio; postoperative recurrence; prognosis.