DAI Chen, GE Yali, GAO Ju, WU Rui. Value of neutrophil to lymphocyte ratio in predicting postoperative delirium of elderly patients with laparoscopic surgery for gastrointestinal tumors[J]. Journal of Clinical Medicine in Practice, 2023, 27(11): 103-107. DOI: 10.7619/jcmp.20230927
Citation: DAI Chen, GE Yali, GAO Ju, WU Rui. Value of neutrophil to lymphocyte ratio in predicting postoperative delirium of elderly patients with laparoscopic surgery for gastrointestinal tumors[J]. Journal of Clinical Medicine in Practice, 2023, 27(11): 103-107. DOI: 10.7619/jcmp.20230927

Value of neutrophil to lymphocyte ratio in predicting postoperative delirium of elderly patients with laparoscopic surgery for gastrointestinal tumors

More Information
  • Received Date: March 21, 2023
  • Revised Date: May 22, 2023
  • Available Online: June 24, 2023
  • Objective 

    To explore the value of perioperative neutrophil to lymphocyte ratio (NLR) in predicting postoperative delirium (POD) of elderly patients with gastrointestinal tumor surgery.

    Methods 

    A total of 185 elderly patients with selective laparoscopic surgery for gastrointestinal tumors were selected. Before surgery, the patient′s cognitive function was evaluated by the Mini-Mental State Examination (MMSE); from the first day to the seventh day after surgery, the incidence of POD in patients was evaluated by the Confusion Assessment Method (CAM), and they were divided into POD group and NPOD group. The general materials of the patients before surgery, perioperative conditions, and partial laboratory examination results[neutrophil count, lymphocyte count and C-reactive protein (CRP)]at 1 day before surgery and 1 day, 3 and 5 days after surgery were recorded, and the NLR value was calculated. The predictive value of NLR for POD was analyzed by multiple factor Logistic regression analysis and receiver operating characteristic (ROC) curve.

    Results 

    Among the 185 patients, 35 patients had POD, and patients with histories of smoking and cerebral infarction had an increased risk of delirium (P < 0.05). The preoperative NLR and CRP levels in the POD group were significantly higher than those in the NPOD group, the preoperative hemoglobin level was significantly lower than that in the NPOD group, and the CRP level at 1 day after operation and the NLR level at 3 days after operation were significantly higher than those in the NPOD group (P < 0.05). Multi-factor Logistic regression analysis showed that preoperative NLR and CRP levels were the independent risk factors for the occurrence of POD (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of preoperative NLR level for predicting POD was 0.726, with the optimal critical value of 2.225, sensitivity of 65.7% and specificity of 77.3%; the AUC of preoperative CRP level for predicting POD was 0.649, with the optimal critical value of 7.95 mg/L, sensitivity of 40.0% and specificity of 96.7%; the AUC of preoperative NLR for predicting POD was greater than that of CRP.

    Conclusion 

    Preoperative NLR and CRP levels are the predictive indicators for POD in elderly patients with laparoscopic surgery for gastrointestinal tumors, and preoperative NLR level has better predictive value. Preoperative detection of NLR level has certain value for early prevention and diagnosis of POD.

  • [1]
    DE LA VARGA-MARTÍNEZ O, GUTIÉRREZ-BUSTILLO R, MUÑOZ-MORENO M F, et al. Postoperative delirium: an independent risk factor for poorer quality of life with long-term cognitive and functional decline after cardiac surgery[J]. J Clin Anesth, 2023, 85: 111030. doi: 10.1016/j.jclinane.2022.111030
    [2]
    WEISS Y, ZAC L, REFAELI E, et al. Preoperative cognitive impairment and postoperative delirium in elderly surgical patients - a retrospective large cohort study[J]. Ann Surg, 2022: Online ahead of print.
    [3]
    PANG Y, LI Y T, ZHANG Y G, et al. Effects of inflammation and oxidative stress on postoperative delirium in cardiac surgery[J]. Front Cardiovasc Med, 2022, 9: 1049600. doi: 10.3389/fcvm.2022.1049600
    [4]
    WANG W H, LIU L L, NING Z P, et al. The neutrophil-lymphocyte ratio to predict poor prognosis of critical acute myocardial infarction patients: a retrospective cohort study[J]. Biochem Med, 2023, 33(1): 010702.
    [5]
    JOSHI A, BHAMBHANI A, BARURE R, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as markers of stable ischemic heart disease in diabetic patients: an observational study[J]. Medicine, 2023, 102(5): e32735. doi: 10.1097/MD.0000000000032735
    [6]
    OZEREN E. Is C-reactive protein-albumin ratio or neutrophil-lymphocyte ratio a better indicator to predict in-hospital mortality in traumatic brain injury[J]. Ulus Travma Acil Cerrahi Derg, 2022: 1482.
    [7]
    KARA S P, ALTUNAN B, UNAL A. Investigation of the peripheral inflammation (neutrophil-lymphocyte ratio) in two neurodegenerative diseases of the central nervous system[J]. Neurol Sci, 2022, 43(3): 1799-1807. doi: 10.1007/s10072-021-05507-5
    [8]
    BIOQUE M, CATARINA MATIAS-MARTINS A, LLORCA-BOFÍV, et al. Neutrophil to lymphocyte ratio in patients with a first episode of psychosis: a two-year longitudinal follow-up study[J]. Schizophr Bull, 2022, 48(6): 1327-1335. doi: 10.1093/schbul/sbac089
    [9]
    CHEN Y, LIANG S, WU H W, et al. Postoperative delirium in geriatric patients with hip fractures[J]. Front Aging Neurosci, 2022, 14: 1068278. doi: 10.3389/fnagi.2022.1068278
    [10]
    CASCELLA M, MUZIO M R, BIMONTE S, et al. Postoperative delirium and postoperative cognitive dysfunction: updates in pathophysiology, potential translational approaches to clinical practice and further research perspectives[J]. Minerva Anestesiol, 2018, 84(2): 246-260.
    [11]
    RUMP K, ADAMZIK M. Epigenetic mechanisms of postoperative cognitive impairment induced by anesthesia and neuroinflammation[J]. Cells, 2022, 11(19): 2954. doi: 10.3390/cells11192954
    [12]
    BHIKRAM T, SANDOR P. Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients[J]. Brain Behav Immun, 2022, 105: 237-246. doi: 10.1016/j.bbi.2022.07.006
    [13]
    BORDON Y. Immune cells freeze in response to stress signalling[J]. Nat Rev Immunol, 2021, 21(6): 344-345.
    [14]
    KULAKSIZOGLU B, KULAKSIZOGLU S. Relationship between neutrophil/lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia[J]. Neuropsychiatr Dis Treat, 2016, 12: 1999-2005. doi: 10.2147/NDT.S110484
    [15]
    KOTFIS K, BOTT-OLEJNIK M, SZYLIÑSKA A, et al. Could neutrophil-to-lymphocyte ratio (NLR) serve as a potential marker for delirium prediction in patients with acute ischemic stroke A prospective observational study[J]. J Clin Med, 2019, 8(7): 1075. doi: 10.3390/jcm8071075
    [16]
    DUNNE S S, COFFEY J C, KONJE S, et al. Biomarkers in delirium: a systematic review[J]. J Psychosom Res, 2021, 147: 110530. doi: 10.1016/j.jpsychores.2021.110530
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