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Purpose <p>Neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), and red cell distribution width (RDW) are values derived from the complete blood count (CBC) that serve as indirect markers of inflammatory states. We aimed to evaluate their ability to predict mortality and intensive care unit (ICU) stay in perioperative adult patients.</p> Methods <p>We conducted a single-centre retrospective cohort study of 53,375 perioperative patients (≥ 21&#xa0;yr) admitted to Singapore General Hospital between 2017 And 2020. We used differentiated blood cell counts acquired at preoperative assessment to obtain NLR, PLR, and RDW. We used multivariable logistic regression models and the area under the receiver operating curve (AUROC) to assess different cut-offs for each of the different inflammatory markers.</p> Results <p>The observed 30-day mortality was 0.9% (497/53,375). Among all perioperative patients, 2.2% (1,201/53,375) had an ICU admission &gt; 24&#xa0;hr. Elevated NLR, PLR, And RDW values were predictive of 30-day mortality and ICU stay &gt; 24&#xa0;hr on univariable analysis.</p> <p>On multivariable Analysis, the models for 30-day mortality that included a single inflammatory index showed that the index was statistically significant (RDW odds ratio [OR], 2.69; RDW 95% confidence interval [CI], 2.10 to 3.44; model A3 NLR OR, 2.40; model A3 95% CI, 1.89 to 3.06; model A4 PLR OR, 1.91; model A4 95% CI, 1.50 to 2.43). When we included all three inflammatory indices together, RDW (OR, 2.61; 95% CI, 2.04 to 3.33) and NLR (OR, 2.07; 95% CI, 1.58 to 2.72) were statistically significant, and this model had a statistically significantly better AUROC than a model that did not include any inflammatory index.</p> Conclusion <p>Elevated inflammatory indices were significantly associated with 30-day mortality and ICU stay of &gt; 24&#xa0;hr. In multivariable Analysis, they improved the prediction of 30-day mortality risk. Nevertheless, further validation of the use of these indirect inflammatory indices as predictors for the aforementioned outcomes is needed.</p>

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Preoperative inflammatory markers for prediction of postoperative clinical outcomes: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年10月22日

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  • Jason C. H. Goh,
  • Daniel Y. Z. Lim,
  • Yuhe Ke,
  • Jolin Wong,
  • Hairil R. Abdullah

摘要

Purpose

Neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), and red cell distribution width (RDW) are values derived from the complete blood count (CBC) that serve as indirect markers of inflammatory states. We aimed to evaluate their ability to predict mortality and intensive care unit (ICU) stay in perioperative adult patients.

Methods

We conducted a single-centre retrospective cohort study of 53,375 perioperative patients (≥ 21 yr) admitted to Singapore General Hospital between 2017 And 2020. We used differentiated blood cell counts acquired at preoperative assessment to obtain NLR, PLR, and RDW. We used multivariable logistic regression models and the area under the receiver operating curve (AUROC) to assess different cut-offs for each of the different inflammatory markers.

Results

The observed 30-day mortality was 0.9% (497/53,375). Among all perioperative patients, 2.2% (1,201/53,375) had an ICU admission > 24 hr. Elevated NLR, PLR, And RDW values were predictive of 30-day mortality and ICU stay > 24 hr on univariable analysis.

On multivariable Analysis, the models for 30-day mortality that included a single inflammatory index showed that the index was statistically significant (RDW odds ratio [OR], 2.69; RDW 95% confidence interval [CI], 2.10 to 3.44; model A3 NLR OR, 2.40; model A3 95% CI, 1.89 to 3.06; model A4 PLR OR, 1.91; model A4 95% CI, 1.50 to 2.43). When we included all three inflammatory indices together, RDW (OR, 2.61; 95% CI, 2.04 to 3.33) and NLR (OR, 2.07; 95% CI, 1.58 to 2.72) were statistically significant, and this model had a statistically significantly better AUROC than a model that did not include any inflammatory index.

Conclusion

Elevated inflammatory indices were significantly associated with 30-day mortality and ICU stay of > 24 hr. In multivariable Analysis, they improved the prediction of 30-day mortality risk. Nevertheless, further validation of the use of these indirect inflammatory indices as predictors for the aforementioned outcomes is needed.