Predictive value of preoperative inflammatory response markers on short-term postoperative complications following colorectal surgery: a secondary analysis of a randomized clinical trial

Background: Numerous inflammatory biomarkers have been identified to possess a positive prognostic value in relation to the clinical outcomes of patients with various cancers. Despite this, there is a paucity of comprehensive studies that compare the prognostic value of commonly used inflammatory parameters specifically within colorectal cancer (CRC) populations. These parameters include the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI). Thus, the objective of this research was to conduct a thorough comparison of the predictive potential value of preoperative commonly used inflammatory response markers in CRC patients. Methods: This is a retrospective, single-center cohort analysis. We performed a secondary analysis of 392 individuals with CRC who fulfilled our inclusion criteria and were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between June 2018 and August 2019. Initially, the clinical data including baseline demographics, laboratory indices, type of surgery, type of anesthesia, and postoperative complications were collected. Then, the prognostic efficacy and threshold values of preoperative inflammatory biomarkers were ascertained through the employment of receiver operating characteristic (ROC) curves. Finally, both univariate and multivariate analyses were conducted to discern the risk factors contributing to postoperative complications with CRC patients. Results: In the present study, 54 (13.78%) patients experienced surgical complications. According to ROC curve analysis, PNI possessed the strongest predictive ability for surgical complications (AUC = 0.706, 95% CI = 0.642–0.770; p = 0.001). Concurrently, the cut-off value of PNI was 48.78 based on the highest Youden index. Multivariate analysis demonstrated that PNI ≤ 48.78 (OR = 0.904, 95% CI = 0.844–0.967, p = 0.003) and laparotomy (OR = 1.863, 95% CI = 1.017–3.415, p = 0.044) emerged as independent risk factors for short-term postoperative complications. Lastly, the PNI ≤ 48.78 group exhibited an increased likelihood of requiring intraoperative blood transfusions and experienced extended duration of hospitalization. Conclusion: Preoperative PNI possesses superior ability and serves as an independent predictor of clinical complications following colorectal resection surgery. Multidisciplinary teams should focus on addressing patients' immunonutrition status before surgery.