title: Postoperative Elevation of the Neutrophil: Lymphocyte Ratio Predicts Complications Following Esophageal Resection.
abstract: BACKGROUND
  Complications following esophagectomy are a significant source of morbidity. The aim of this study was to investigate the utility of the neutrophil:lymphocyte ratio (NLR) in the early identification of complications following esophagectomy, as compared to other routinely available parameters.
  
  
  METHODS
  We performed a retrospective cohort study of patients undergoing Ivor-Lewis esophagectomy at a single centre. Baseline characteristics and complications occurring within the first 30 days of surgery were recorded. White blood cell counts and C-reactive protein (CRP) levels immediately following surgery (day 0) and over the subsequent three postoperative days were analysed.
  
  
  RESULTS
  Sixty-five patients were included, of whom 29 (45 %) developed complications. The median NLR was similar among patients with and without a complicated recovery on day 0 (12.7 vs 13.6, p = 0.70) and day 1 (10.0 vs 9.3, p = 0.29). Patients who subsequently developed complications had a higher NLR on day 2 (11.8 vs 7.5, p < 0.001) and day 3 (9.0 vs 6.5, p = 0.001) compared to those whose recovery was uncomplicated. Receiver-operating-characteristic plots for the diagnostic performance of the NLR, neutrophil count, lymphocyte count and CRP level at each time point demonstrated that the NLR on day 2 had the greatest discriminatory ability in predicting complications, with an area under the curve of 0.83 (95 % CI 0.73-0.94). An NLR of >8.3 on day 2 had a sensitivity of 93 % and a specificity of 72 % for predicting complications.
  
  
  CONCLUSIONS
  The NLR is a simple and routinely available parameter which has a high sensitivity in the early detection of complications following esophagectomy.
authors.affiliation: Department of General Surgery, Queen's Hospital, Rom Valley Way, Romford, RM7 0DG, UK. paul.vulliamy@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Vulliamy
authors.affiliation: Department of General Surgery, Queen's Hospital, Rom Valley Way, Romford, RM7 0DG, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: McCluney
authors.affiliation: Department of General Surgery, Queen's Hospital, Rom Valley Way, Romford, RM7 0DG, UK.
authors.forename: Samrat
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of General Surgery, Queen's Hospital, Rom Valley Way, Romford, RM7 0DG, UK.
authors.forename: Luke
authors.initials: L
authors.lastname: Ashby
authors.affiliation: Department of General Surgery, Queen's Hospital, Rom Valley Way, Romford, RM7 0DG, UK.
authors.forename: Thangadorai
authors.initials: T
authors.lastname: Amalesh
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000097:blood / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
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