C-反应蛋白与清蛋白比值对微创食管癌术后并发症的早期预测价值

Predictive value of the postoperative ratio of C-reactive protein to albumin for complications afterminimally invasive esophageal surgery

目的 C-反应蛋白与清蛋白比值(CAR)与肿瘤患者的临床预后相关,但微创食管癌术后CAR与并发症的关系尚未明确。文中对CAR在微创食管癌术后早期预测并发症的价值进行评估。方法回顾性分析2014年9月至2017年10月在南京军区南京总医院心胸外科择期行微创食管癌手术的患者,共有209例患者入组。应用单因素和多因素分析被用于鉴别术后并发症的危险因素。绘制受试者工作特征(ROC)曲线确立CAR和CRP的截断值并比较两者在术后早期预测并发症的灵敏度、特异度和阳性预测值等。结果 209例中有55例(26.3%)患者术后出现并发症。CAR是微创食管癌术后并发症的独立危险因素(OR=6.522;95%CI:2.247~18.934;P<0.001)。术后第3天CAR曲线下面积大于CRP(0.841 vs 0.776)。CAR的截断值为4.1,其预测术后并发症的灵敏度和特异度均优于CRP,尤其是阳性预测值明显更高。术后第3天CAR≥4.1者术后并发症发生率较CAR<4.1者明显增高(70.2%vs 9.9%,P<0.001),同时术后住院天数也明显延长[(15.9±10.0)d vs(11.4±7.1)d,P=0.002]。结论微创食管癌术后第3天CAR有助于早期预测术后并发症风险,且较CRP有着更高的预测价值,可指导临床早期检测和干预,以利于食管癌患者术后加速康复。

Objective The ratio of C-reactive protein to albumin（ CAR） is associated with clinical outcomes in cancer patients. However,the relationship between CRP/albumin ratio and postoperative complications in minimally invasive esophageal surgery is still unclear. We hypothesize the predictive value of CAR in minimally invasive esophageal surgery for postoperative complications.Methods A total of 209 patients undergoing minimally invasive esophageal surgery in Nanjing General Hospital of Nanjing Military Region between 2014 and 2017 were eligible for this study. The risk factors for postoperative complications were statistic analyzed by using univariate and multivariate analyses. Receiver operating characteristic（ ROC） curves were utilized to figure out the cutoff values of CAR and postoperative C-reactive protein（ CRP） levels and predictive value indexes,including sensitivity,specificity and positive predictive value. Results Fifty-five（ 26.3%） cases of 209 patients were diagnosed with postoperative complications. CAR was an independent risk factor for complications（ OR 6.522; 95% CI 2.247-18.934; P〈0. 001）. ROC curve analysis revealed that the area under the curve of CAR was higher than that of CRP on postoperative day 3（ 0. 841 vs 0. 776）. The cutoff value of CAR was 4.1. The sensitivity,specificity, especially positive predictive value of CAR was higher than those of CRP on postoperative day 3. Patients with CAR≥4.1 were suffered more postoperative complications（ 70. 2% vs 9.9%,P〈0. 001） and longer postoperative stays [（ 15.9±10. 0） days vs（ 11.4±7.1） days,P= 0. 002]than those with CAR〈4.1. Conclusion The ratio of C-reactive protein to albumin could lead to identify patients with a high probability of postoperative complications. The ratio was higher predictive value than C-reactive protein alone for postoperative complications in minimally invasive esophageal surgery. CAR could be utilized for the early detection and treatments of postoperative complications,subsequently guiding to enhanced recovery after surgery.