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Higher neutrophil-to-lymphocyte ratio, mean platelet volume, and platelet distribution width are associated with postoperative delirium in patients undergoing esophagectomy: a retrospective observational study



We investigated whether preoperative inflammatory markers, i.e., the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) can predict the development of postoperative delirium (POD) after esophagectomy.

Patients and methods

This single-center, retrospective, observational study included 110 patients who underwent an esophagectomy. We assigned the patients with the Intensive Care Delirium Screening Checklist score ≥ 4 to the POD group. We performed multivariable logistic regression analyses to determine whether the NLR, PLR, MPV, and PDW can be used to predict the development of POD.


The POD group had 20 patients; the non-POD group included the other 90 patients. Although only the preoperative NLR in the POD group was significantly higher than in the non-POD group (3.20 [2.52–4.30] vs. 2.05 [1.45–3.02], p = 0.001), multivariable logistic regression analyses showed that the following three parameters were independent predictors of POD: preoperative NLR ≥ 2.45 (adjusted odds ratio [aOR]: 8.68, 95%CI 2.33–32.4, p = 0.001), MPV ≥ 10.4 (aOR: 3.93, 95%CI: 1.37–11.2, p = 0.011), and PDW ≥ 11.8 (aOR: 3.58, 95%CI: 1.22–10.5, p = 0.020).


Our analysis results demonstrated that preoperative NLR ≥ 2.45, MPV ≥ 10.4, and PDW ≥ 11.8 were significantly associated with a higher risk of POD after adjustment for possible confounding factors. However, as the AUCs of the preoperative MPV and PDW for the prediction of the development of POD in univariable ROC analyses were low, large prospective studies are needed to confirm this result.

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Author information




TO, HK, and DT collected the data. TO, DT, and JS analyzed the data and drafted the manuscript. TK and KH extensively revised the manuscript. All authors read and approved the final manuscript for submission.

Corresponding author

Correspondence to Daiki Takekawa.

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Oyama, T., Kinoshita, H., Takekawa, D. et al. Higher neutrophil-to-lymphocyte ratio, mean platelet volume, and platelet distribution width are associated with postoperative delirium in patients undergoing esophagectomy: a retrospective observational study. J Anesth (2021).

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  • Esophagectomy
  • Postoperative delirium
  • Neutrophil-to-lymphocyte ratio
  • Mean platelet volume
  • Platelet distribution width