Role of Neutrophil Lymphocyte Ratio in Early Detection of Septic Complications After Major Operations

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Recent advances in medical and surgical techniques with a better understanding of the pathophysiology of disease condition have made operations safe. However, post-operative sepsis remains a dreaded complication. Early identification and prompt treatment have shown to be effective in decreasing morbidity and mortality associated with septic complications. Various biochemical markers such as serum lactate level, interleukin 6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP)etc have shown to be early markers of subsequent post-operative sepsis. But these investigations are not universally available and are relatively expensive. These limits their use most of the centres. Recently there has been interest in Neutrophil Lymphocyte ratio (NLR) as a marker of inflammation and its clinical use as a septic marker. Zahorec et al studied 90 oncological patients who had undergone elective, emergency operations and medical intensive care patients treated for severe sepsis and septic shock. They showed a correlation between the severity of clinical course grades of neutrophilia and lymphocytopenia. They suggested that the term Neutrophil-lymphocyte stress factor which is a ratio of neutrophil to lymphocyte counts. Since then NLR has been used and studied in various clinical settings such as bacteremia, sepsis, acute pancreatitis, and acute cholecystitis, prognostic markers in esophageal and colonic malignancy. NLR has also been used as a surrogate marker of resectability in patients with pancreatic adenocarcinoma. NLR has also been studied in cardiovascular patients and patients undergoing coronary artery bypass graft as a prognostic marker. P. G. Vaughan-Shaw et al studied C-reactive protein (CRP) and NLR in outcome prediction after emergency abdominal surgery in the elderly patients. They used mortality at 30 days, 6 months and 12 months as end points. They identified NLR to be an independent predictor of 30-day outcome in multivariate analysis. Gurol et al studied NLR and compared with PCT level to identify the NLR cut off for bacteremia by using PCT as a reference. They found a positive correlation between PCT and NLR (0.2582, p<0.001). They suggested the cut-off value of = 5 as the marker of bacteremia and sepsis. Though NLR has been studied in various clinical settings it has not been studied as the marker of postoperative sepsis. The aim of this study is to investigate the role of NLR as an early predictor of postoperative septic complications.

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