Background/Objectives: Anastomotic leakage (AL) is one of the most concerning complications following gastrectomy. The aim of this study was to assess and compare the predictive accuracy of C-reactive protein (CRP), procalcitonin (PCT), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), fibrinogen, and the mean platelet volume (MPV) in the early diagnosis of post-gastrectomy AL. Methods: A prospective bicentric observational study was conducted including all patients undergoing elective gastrectomy between August 2018 and December 2022. The performance of the selected biomarkers in predicting the existence of AL within the first 7 postoperative days (PODs) was assessed. Results: A total of 107 patients were included for analysis. The incidence of AL was 20.56%, and the median day of diagnosis was on POD5 (interquartile range 4–6). CRP, PCT, the NLR, the PLR, and fibrinogen showed significant associations with the presence of AL (from POD2 for CRP and fibrinogen and from POD3 for PCT, NLR, and PLR). CRP demonstrated a superior predictive accuracy on POD4, with a threshold value of 181.4 mg/L (NPV 99%; AUC 0.87,p< 0.001); PCT demonstrated a superior predictive accuracy on POD7, with a threshold value of 0.13 μg/L (NPV 98%; AUC 0.84,p< 0.001); the NLR showed a superior predictive accuracy on POD6, with a threshold ratio of 6.77 (NPV 95%; AUC 0.86,p< 0.001); the PLR achieved a superior predictive accuracy on POD7, with a ratio of 234 (NPV 98%; AUC 0.71;p= 0.002); and fibrinogen demonstrated a superior predictive accuracy on POD5, with a threshold of 7.344 g/L (NPV 98%; AUC 0.74;p= 0.003). In the comparison of predictive accuracy, CPR, PCT, and the NLR were found to be superior to all other biomarkers. Conclusions: CRP, PCT, and the NLR are biomarkers with a sufficient predictive ability to clinically discard the presence of AL within the first postoperative week.
背景/目的：吻合口漏是胃切除术后最值得关注的并发症之一。本研究旨在评估并比较C反应蛋白、降钙素原、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、纤维蛋白原及平均血小板体积在胃切除术后吻合口漏早期诊断中的预测准确性。方法：开展一项前瞻性双中心观察性研究，纳入2018年8月至2022年12月期间所有接受择期胃切除术的患者。评估所选生物标志物在术后7天内预测吻合口漏发生的效能。结果：共纳入107例患者进行分析。吻合口漏发生率为20.56%，诊断中位时间为术后第5天（四分位距4-6天）。C反应蛋白、降钙素原、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值及纤维蛋白原均与吻合口漏存在显著相关性（C反应蛋白与纤维蛋白原自术后第2天起，降钙素原、中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值自术后第3天起）。C反应蛋白在术后第4天预测效能最优，阈值为181.4 mg/L（阴性预测值99%；受试者工作特征曲线下面积0.87，p<0.001）；降钙素原在术后第7天预测效能最优，阈值为0.13 μg/L（阴性预测值98%；曲线下面积0.84，p<0.001）；中性粒细胞与淋巴细胞比值在术后第6天预测效能最优，临界比值为6.77（阴性预测值95%；曲线下面积0.86，p<0.001）；血小板与淋巴细胞比值在术后第7天预测效能最优，临界比值为234（阴性预测值98%；曲线下面积0.71，p=0.002）；纤维蛋白原在术后第5天预测效能最优，阈值为7.344 g/L（阴性预测值98%；曲线下面积0.74，p=0.003）。在预测准确性比较中，C反应蛋白、降钙素原和中性粒细胞与淋巴细胞比值优于其他所有生物标志物。结论：C反应蛋白、降钙素原和中性粒细胞与淋巴细胞比值是具有足够预测能力的生物标志物，可在临床实践中用于排除术后第一周内吻合口漏的发生。
Usefulness of Serum Biomarkers in Predicting Anastomotic Leakage After Gastrectomy
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