Prediction Value Of White Blood Cell,C-reactive Protein And Albumin In Early Anastomotic Leakage After Radical Resection Of Colorectal Cancer And Construction Of Nomogram Prediction Model

Objective: Explore the predictive value of white blood cell(WBC),C-reactive protein(CRP),Albumin(ALB)and C-reactive protein / albumin ratio(CAR)in early anastomotic leakage(AL)after radical resection of colorectal cancer,and to construct a nomogram to predict the risk of AL.Methods: This study was a retrospective case-control study.Select 153 patients who performed radical resection of colorectal cancer in the Department of Gastrointestinal surgery of the second affiliated Hospital of Nanchang University from January 2019 to June 2021.According to the occurrence of anastomotic leakage 7 days after operation,the patients were divided into anastomotic leakage(AL)group and nonanastomotic leakage(NAL)group.Record the levels of white blood cell(WBC)CRP and ALB before operation and on the 1st,4th and 7th day(POD1,4,7)after operation.The accuracy of predicting AL by CRP,ALB,CRP(POD4/POD1),CAR and WBC on the 4th day after operation was compared by drawing the receiver working(ROC)curve.Multi-factor Logistics regression analysis of risk factors of AL,construct the nomogram,and draw its correction curve and ROC curve.Results: There was no difference in age,body mass index(Body mass index,BMI),operation site and tumor stage between AL group and NAL group,but the hospitalization time of AL group was significantly longer than that of NAL group.On the 1st,4th and 7th day after operation,CRP and CAR in AL group were higher than those in NAL group,while ALB was lower than that in NAL group.CRP(POD4/POD1)in AL group was significantly higher than that in NAL group,but there was no difference between ALB(POD4/POD1)in NAL group.In the analysis of ROC curve,the area under the curve(AUC)of CAR,CRP,ALB,CRP(POD4/POD1)and WBC on the 4th day after operation were 0.853,0.826,0.780 and0.633,0.808.The best critical values were 2.97,117.14mg/L,32.98g/L 2.11,and9.71×10^9.The sensitivity was88.2%,76.5%,88.2%,52.9% and 76.5%.The specificity was 75.7%,82.4%,54.9%,81.6% and 77.9%.On the 4th day after operation,the predictive efficacy of CRP combined with ALB and CAR was similar(AUC0.851vs0.853).Multivariate Logistics regression screening for effective variables showed that WBC(OR=1.596),CRP(OR=1.017)and ALB(OR=0.757) were independent risk factors for AL.By drawing the ROC curve of the nomogram prediction model,the AUC was 0.896,the optimal critical value was 106.25 points,the sensitivity was 82.4%,and the specificity was 87.5%.Conclusion: On the 4th day after operation,CAR is a reliable index for predicting AL after radical resection of colorectal cancer,and its accuracy is higher than that of CRP,ALB,CRP combined with ALB CRP(POD4/POD1)and WBC.The nomogram prediction model constructed by WBC,CRP,and ALB on the 4th postoperative day can effectively predict the occurrence of AL,and the predictive ability is better than that of a single index.