Clinical and laboratory predictors of postoperative infectious complications in patients with colorectal cancer

AIM: to determine the prognostic significance of clinical and laboratory parameters in the diagnosis of postoperative infectious complications in patients with colorectal cancer.

PATIENTS AND METHODS: the retrospective single-center study included patients who underwent elective radical surgery for newly diagnosed colorectal cancer with the formation of a primary anastomosis in the period from 2016 to 2024. The endpoints of the study were to determine predictors of the development of infectious complications in the early postoperative period and compare the preoperative level of inflammatory markers in the group with and without infectious complications. The logistic regression model included demographic and clinical and laboratory parameters, including complex indicators NLR (neutrophil-lymphocyte ratio), PLR (platelet-lymphocyte ratio), SII (systemic immune-inflammation index), SIRI (systemic inflammation response index). The significance of the influence of predictors on the risk of complications was assessed using the odds ratio (OR), 95% confidence interval (CI), and significance level (p-value).

RESULTS: a total of 381 patients were included in the analysis, of which 43 (11.3%) patients with infectious complications and 338 (88.7%) patients without infectious complications. Patients with postoperative infectious complications were more likely to have cT3-4 tumor (86.0% vs. 68.6%, p = 0.018), as well as higher leukocyte levels (6.5 × 10⁹/l, IQR (Interquartile Range) 5.2–8.2 vs. 6.8 × 10⁹/l, IQR 6.0–8.4, p = 0.002), NLR (208.0, IQR 119.0–217.0 vs. 208.0, IQR 123.0–306.0, p = 0.007), SII (578.9, IQR 385.8–939.3 vs. 765.9, IQR 457.8–1463.6, p = 0.004), SIRI (1.2, IQR 0.8–2.0 vs. 1.7, IQR 1.0–2.9, p = 0.006). Based on the results of a univariate logistic regression analysis, the following predictors of the development of infectious complications in the early postoperative period were determined: stage cT3-4 (OR 2.82, 95% CI 1.15–6.88, p = 0.02), NLR (OR 1.06, 95% CI 1.01–1.13, p = 0.03), PLR (OR 1.002, 95% CI 1.001–1.003, p = 0.04), SII (OR 1.0003, 95% CI 1.00006–1.0004, p = 0.01) and SIRI (OR 1.04, 95% CI 1–1,09, p = 0.05). According to the results of a multivariate analysis, the independent predictors of infectious complications were the stage cT3-4 (OR 2.82, 95% CI (1.15–6.88), p = 0.02) and SII (OR 1.0003, 95% CI (1.00006–1.0004) p = 0.01). The sensitivity of the proposed model was 71.8% (95% CI 63.2–80.4%), specificity was 63.5% (95% CI 57.2–69.8%), AUC = 0.671, (95% CI 0.635–0.707, p = 0.038).

CONCLUSION: the presented prognostic model predicts the likelihood of a patient having an infectious complication in the early postoperative period.

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