The Correlation Between Preoperative And Postoperative NLR、WBC And CRP With Their Trends And Postoperative Anastomotic Leakage In Colorectal Cancer

Objective:To explore the value of the Neutrophil/lymphocyte ratio（NLR）、white blood cell and C-reaction protein（C-reaction）in serum and their changes during the perioperative period in predicting the occurrence of anastomotic leakage after surgery in patients of colorectal cancer.Methods:Retrospective analyze the clinical information of 317 patients with colorectal cancer were admission from January 2017 to January 2020 in The second Affiliated Hospital of Guangxi Medical university.According to the anastomotic leakage or not,the patients were divided into anastomotic leakage group（22 cases）and non-anastomotic leakage group（295 cases）.According to whether anastomotic leakage was present or not,the patients were divided into anastomotic leakage group（22 cases）and non-anastomotic leakage group（295cases）.The serum leukocyte neutrophil-lymphocyte ratio,white blood cell and C-reactive protein（CRP）of the patients before and after operation was collected.At the same time,the general information of the patients,including age and sex,body mass index（BMI kg/m）,complications（diabetes mellitus and hypertension）,previous history of intestinal surgery,smoking,drinking,neoadjuvant chemotherapy before surgery,combined with intestinal obstruction before surgery（open laparoscopy）,tumor stage,length of surgery and tumor location ASA Classification of Anesthesia were also observed.First,preoperative general data and observed serum indicators were analyzed by univariate analysis,and then logistics stepwise regression analysis was performed based on the univariate data.Ch-square test continuity correction or Fisher exact probability method was used for counting data,and t test was used for measurement data.The optimal cut-off point was obtained according to ROC curve and Logistic Regression equations were used for multivariate analysis.Results:The serum NLR and WBC levels of patients with anastomotic leakage at2^nd day post-operation in the anastomotic leakage group were significantly higher than those in the non-anastomotic leakage group the same as the WBC,CRP and NLR in the 3rd and 5th day after surgery,and the difference was statistically significant（P<0.05）.In logistic regression analysis,the p NLR5,p WBC5 and p CRP5 was included in the regression equation,and the prediction model was as follows:risk factor（R）=-17.637+0.205×p WBC5+1.656×p NLR5+0.089×p CRP5.When the risk factor（R）=0.042,Yuden index was the highest,and the sensitivity was 100%and the specificity was 92.5%in predicting postoperative anastomotic leakage,the area under the ROC curve（AUG）is 0.992.And the ROC curve indicates that when p NLR5>3.86（sensitivity 81.8%,specificity 91.5%,area under curve 0.890,P<0.001）,p WBC5>11.12×109/L（sensitivity 86.4%,specificity 84.7%,area under curve 0.848,P<0.001）,p CRP5>25.63 mg/L（sensitivity 100%,specificity 88.8%,area under curve 0.974,P<0.001）was significant for the diagnosis of AL after colorectal cancer（P<0.001）.Conclusions:The continuous increase of NLR,WBC and CRP during the 1st to5th postoperative day is a risk factor for the occurrence of postoperative anastomotic fistula in colorectal cancer,and the established prediction model has certain significance for the prediction of AL.The p NLR5>3.86,p WBC5>11.12×109/L p CRP5>25.63mg/L were existed at the same time on the 5th day after operation,the occurrence of postoperative AL should be vigilant,and corresponding preventive measures should be taken according to the clinical manifestations...