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The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.

Methods

A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann–Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.

Results

One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80–96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.

Conclusion

Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.

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Authors and Affiliations

  1. Division of GI Surgery, Wirral University Teaching Hospitals, Wirral, UK

    G. Simpson, J. Wilson & C. Magee

  2. University of Liverpool Division of Oncology and Surgery, Liverpool, UK

    R. Saunders

Authors
  1. G. Simpson
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  2. R. Saunders
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  3. J. Wilson
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  4. C. Magee
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Corresponding author

Correspondence to C. Magee.

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Conflict of interest

Mr Gregory Simpson states that he has no conflict of interest. Ms Rebecca Saunders states that he has no conflict of interest. Mr Jeremy Wilson states that he has no conflict of interest. Mr Conor Magee states that he has no conflict of interest

Research involving human participants and/or animals

For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

See Table 1

Table 1 Baseline characteristics of patients over 80 undergoing emergency laparotomy
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Simpson, G., Saunders, R., Wilson, J. et al. The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group. Eur J Trauma Emerg Surg 44, 877–882 (2018). https://doi.org/10.1007/s00068-017-0869-4

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  • DOI: https://doi.org/10.1007/s00068-017-0869-4

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