肌酐与胱抑素C比值对腹腔镜结直肠癌术后并发症的预测:一项回顾性研究

Creatinine to cystatin C ratio as a predictor of complications after laparoscopic colorectal cancer surgery:a retrospective study

目的探讨肌酐与胱抑素C比值对结直肠癌患者术后30 d内并发症发生的预测价值。方法收集2021年1月至2022年12月广西医科大学第一附属医院结直肠肛门外科收治的接受腹腔镜结直肠癌根治术的患者的临床资料。根据Clavien-Dindo(CD)分级对术后30 d内发生的并发症进行记录和分级。通过单因素和多因素Logistic回归分析探讨结直肠癌术后并发症的独立影响因素。绘制ROC曲线以评估预测效能及获得最佳临界值。根据最佳临界值,比较不同水平的肌酐与胱抑素C比值患者的临床病理特征。结果本研究纳入846例接受腹腔镜手术的结直肠癌患者,其中男性540例,女性306例。206例患者出现CD分级≥Ⅱ级的术后并发症,发生率为24.4%。并发症组在年龄、糖尿病史、术中失血量、胱抑素C、肌酐、肌酐与胱抑素C比值与对照组的比较差异有统计学意义(P<0.05)。单因素Logistic回归分析结果显示,年龄、糖尿病史、肌酐、胱抑素C、肌酐与胱抑素C比值和中性粒细胞与淋巴细胞比值与术后并发症的发生相关(P<0.05)。多因素Logistic回归分析结果显示,年龄≥75岁(OR=1.777,95%CI为1.054~2.995,P=0.031)和中性粒细胞与淋巴细胞比值(OR=1.128,95%CI为1.002~1.271,P=0.046)是术后并发症发生的独立危险因素。肌酐与胱抑素C比值(OR=0.020,95%CI为<0.001~0.841,P=0.040)是术后并发症发生的独立保护因素。ROC曲线分析显示,年龄、肌酐与胱抑素C比值和中性粒细胞与淋巴细胞比值的曲线下面积(area under curve,AUC)分别为0.540、0.653、0.517,术前肌酐与胱抑素C比值预测术后并发症的临界值为0.895。根据该临界值将患者归为高肌酐与胱抑素C比值组(n=449)与低肌酐与胱抑素C比值组(n=397)。两组患者在年龄、性别、BMI、ASA分级、白蛋白、肌酐、胱抑素C、红细胞计数和血红蛋白水平方面的比较差异有统计学意义(P<0.05)。结论肌酐与胱抑素C比值对结直肠癌患者术后并发症具有一定的预测价值作用。高龄、女性、贫血、营养不良可能对结直肠癌患者的肌肉质量有不利影响,但仍需更多研究结果的证实。

Objectives To investigate the predictive value of creatinine to cystatin C ratio for the occurrence of complications in colorectal cancer patients within 30 days after surgery.Methods Clinical data of patients admitted to the Department of Colorectal and Anal Surgery of the First Affiliated Hospital of Guangxi Medical University who underwent laparoscopic radical surgery for colorectal cancer from January 2021 to December 2022 were collected.Complications occurring within 30 days after surgery were recorded and graded according to the Clavien-Dindo(CD)classification.Univariate and multivariate Logistic regression analyses were performed to identify independent influences on postoperative complications.ROC curves were plotted to assess predictive efficacy as well as to obtain the cut-off point.Clinicopathologic characteristics of different levels of creatinine to cystatin C ratio were compared according to the cut-off point.Results This study included 846 patients with colorectal cancer who underwent laparoscopic radical surgery,including 540 males and 306 females.There are 206 patients had postoperative complications of CD grade≥II,with an incidence of 24.4%.The differences between the complication group in terms of age,diabetes,intraoperative blood loss,cystatin C,creatinine,and creatinine to cystatin C ratio compared with the control group were statistically significant(P<0.05).The results of univariate Logistic regression analysis showed that age,diabetes,creatinine,cystatin C,creatinine to cystatin C ratio,and neutrophil to lymphocyte ratio were associated with the occurrence of postoperative complications(P<0.05).The results of multivariate Logistic regression analysis showed that age≥75 years(OR=1.777,95%CI 1.054-2.995,P=0.031)and neutrophil to lymphocyte ratio(OR=1.128,95%CI 1.002-1.271,P=0.046)were the independent risk factors for the occurrence of postoperative complications.In addition,creatinine to cystatin C ratio(OR=0.020,95%CI<0.001-0.841,P=0.040)was an independent protective factor for the occurrence of postoperative complications.The ROC curve analysis showed that the area under the curve(AUC)for age,creatinine to cystatin C ratio,and neutrophil to lymphocyte ratio,respectively,were 0.540,0.653,and 0.517,and the cut-off point of preoperative creatinine to cystatin C ratio for predicting postoperative complications was 0.895.Patients were categorized into a high creatinine to cystatin C ratio group(n=449)versus a low creatinine to cystatin C ratio group(n=397)based on this cut-off point.The differences between the two groups were statistically significant(P<0.05)in terms of age,gender,BMI,ASA classification,albumin,creatinine,cystatin C,red blood cell count and hemoglobin levels.Conclusion The creatinine to cystatin C ratio has a certain predictive value for postoperative complications in patients with colorectal cancer.Older age,female,anemia,and malnutrition may have adverse effects on muscle mass in patients with colorectal cancer,but more research results are still needed.