Journal of Clinical Monitoring and Computing

, Volume 33, Issue 6, pp 1043–1054 | Cite as

Usefulness of combining clinical and biochemical parameters for prediction of postoperative pulmonary complications after lung resection surgery

  • Ignacio GaruttiEmail author
  • Francisco De la Gala
  • Patricia Piñeiro
  • Lisa Rancan
  • Elena Vara
  • Almudena Reyes
  • Luis Puente-Maestu
  • Jose María Bellón
  • Carlos Simón
Original Research


Early detection of patients with a high risk of postoperative pulmonary complications (PPCs) could improve postoperative strategies. We investigated the role of monitoring systemic and lung inflammatory biomarkers during surgery and the early postoperative period to detect patients at high risk of PPCs after lung resection surgery (LRS). This is a substudy of a randomized control trial on the inflammatory effects of anaesthetic drugs during LRS. We classified patients into two groups, depending on whether or not they developed PPCs. We constructed three multivariate logistic regression models to analyse the power of the biomarkers to predict PPCs. Model 1 only included the usual clinical variables; Model 2 included lung and systemic inflammatory biomarkers; and Model 3 combined Models 1 and 2. Comparisons between mathematical models were based on the area under the receiver operating characteristic curve (AUROC) and tests of integrated discrimination improvement (IDI). Statistical significance was set at p < 0.05. PPCs were detected in 37 (21.3%) patients during admission. The AUROC for Models 1, 2, and 3 was 0.79 (95% CI 0.71–0.87), 0.80 (95% CI 0.72–0.88), and 0.93 (95% CI 0.88–0.97), respectively. Comparison of the AUROC between Models 1 and 2 did not reveal statistically significant values (p = 0.79). However, Model 3 was superior to Model 1 (p < 0.001). Model 3 had had an IDI of 0.29 (p < 0.001) and a net reclassification index of 0.28 (p = 0.007). A mathematical model combining inflammation biomarkers with clinical variables predicts PPCs after LRS better than a model that includes only clinical data. Clinical registration number Clinical Trial Registration NCT 02168751; EudraCT 2011-002294-29.


Perioperative period Pulmonary inflammation Postoperative complications Cytokines bronchoalveolar lavage Cytokines blood 



Area under receiver operating characteristic


Bronchoalveolar lavage fluid


Continuous positive airway pressure


Forced expiratory volume in the first second


Forced vital capacity


Intensive care unit




Lung resection surgery


Matrix metalloproteinase


One-lung ventilation


Postoperative pulmonary complication



This work was supported by a Grant of €91,056.02 from the Spanish Ministry of Health (“Aid to independent clinical research”) in the 2011 call. The trial was also funded in 2013 with €20,000 from AbbVie S.L.U. through “Proyecto InvestigAR” in the area of cardiac and thoracic surgery.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Ignacio Garutti
    • 1
    • 6
    Email author
  • Francisco De la Gala
    • 1
  • Patricia Piñeiro
    • 1
  • Lisa Rancan
    • 2
  • Elena Vara
    • 2
  • Almudena Reyes
    • 1
  • Luis Puente-Maestu
    • 3
  • Jose María Bellón
    • 5
  • Carlos Simón
    • 4
  1. 1.Department AnaesthesiaHospital General Marañón (HGUGM)MadridSpain
  2. 2.Department Biochemistry, School of MedicineUniversidad Complutense de Madrid (UCM)MadridSpain
  3. 3.Department PneumologyHGUGMMadridSpain
  4. 4.Department Thoracic SurgeryHGUGMMadridSpain
  5. 5.Department StatisticsHGUGM Biomedical Research FoundationMadridSpain
  6. 6.Department Pharmacology, School of MedicineUCMMadridSpain

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