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Neutrophil to lymphocyte ratio as predictor of surgical mortality and survival in complex surgery of the upper gastrointestinal tract.

BACKGROUND
Neutrophil-lymphocyte ratio (NLR) has been proposed as a marker of inflammatory response and as a prognostic tool in surgical procedures.


OBJECTIVE
To evaluate the role of high preoperative NLR (> 4.5) as predictor of morbidity and mortality in patients with upper gastrointestinal tract resection, and survival in cancer patients.


METHODS
Retrospective study of patients undergoing upper gastrointestinal tract surgery from 2007 to 2012. Variables associated with morbidity, mortality, and survival were analyzed. Univariate and multivariate analyses were performed. Significance was considered at p < 0.05.


RESULTS
548 patients were included. The most common surgical procedures were Whipple (44.3%) and gastrectomy (30.7%). Surgical morbidity was 40.5% and mortality 6.4%. Factors associated with significant surgical complications were: low body mass index, AJCC stage ≥ III and ASA ≥ III. Factors associated with mortality were older patient age, high NLR, AJCC stage ≥ III, ASA ≥ III, blood transfusion and Charlson > 4. On multivariate analysis, only high NLR and Charlson > 4 remained significant. High NLR was significantly associated with reduced survival in patients with malignant neoplasms (three-year survival 76.1 vs. 65.7%; p = 0.04).


CONCLUSION
High preoperative NLR appears to be a biomarker to predict surgical mortality and survival in patients undergoing complex surgery of the upper gastrointestinal tract.