Factors Affecting Perforated Peptic Ulcer Postoperative Complications And The Predictive Value Of NLR、PLR On Perforated Peptic Ulcer Postoperative Complications

Objective: The aim of this study was To analyze the relative factors affecting the grade of postoperative complications in patients with peptic ulcer perforation.To explore the predictive value of neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)in patients with peptic ulcer perforation.Patients and Methods: To collect the data of patients diagnosed with perforation of peptic ulcer and undergoing open surgery in gastrointestinal surgery at the second affiliated Hospital of the University of South China from 2013 to 2019,including general demographic data,clinical data,laboratory data,imaging examination,surgical data and postoperative short-term results etc.According to inclusion and exclusion criteria,181 subjects was included in the study.According to ClavienDindo classification of surgical complications,Among 181 cases I grade152;Grade II 14;III grade 3 cases;IV grade 4 cases;Grade V 8,The patients were divided into five groups by grade,To study the related factors affecting the level of postoperative complications in patients with ulcer perforation using univariate and multivariate analysis;The patients were divided into two groups,Clavien-Dindo< grade 3 166 cases,and Clavien-Dindo≥ grade 3 15 cases.After univariate and multivariate analysis,to explore the predictive value of laboratory indicators,including preoperative NLR and PLR,in the occurrence of grade 3 and above complications in patients with ulcer perforation with Receiver Operating Characteristic Curve(ROC).The accuracy of the prediction is determined by the size of the area under the ROC curve(AUC).Statistical analyses were performed using SPSS 23.0.P<0.05 was considered statistically significant.Results :(1)Factors affecting Postoperative complications grade :age,preoperative hypertension,perforation site,perforation long diameter,albumin level,CRP,PCT,creatinine,urea nitrogen level,lymphocyte count,preoperative NLR and PLR were statistically significant(P<0.05),which were the related factors affecting the postoperative complications grade of perforated peptic ulcer patients.Ordinal logistic regression analysis showed that preoperative NLR,perforation long diameter and albumin level was statistically significant(P<0.05),among which high NLR(P<13.56)and perforation long diameter were independent risk factors for postoperative complications grade,and high albumin level was its protective factor,that is to say,high NLR,larger perforation long diameter,lower albumin level,the higher postoperative complications grade may be.(2)The correlation factors of severity of postoperative complications: age,perforation long diameter,platelet count,albumin level,CRP,PCT,creatinine,urea nitrogen level,preoperative NLR and PLR were statistically significant(P<0.05),which could affect the occurrence of postoperative complications of grade 3 and above.NLR,perforation long diameter and albumin level was statistically significant(P<0.05)by binary logistics regression analysis,in which NLR and perforation long diameter were independent risk factors for postoperative complications,and albumin level was its protective factor,which means that the greater the preoperative NLR,the greater the perforation long diameter,and the lower the albumin level,the higher risk to postoperative complications Clavien-Dindo≥ grade 3.(3)Based on the ROC curve analysis,preoperative NLR >18.77(AUC=0.689,P =0.015),preoperative PLR>349.39(AUC=0.701,P =0.010)and albumin level<36g/L(AUC=0.846,P =0.000)have reference value in predicting the likelihood of grade 3 postoperative complications in patients with perforated peptic ulcer undergoing surgery.Conclusions: 1.age(>65),preoperative hypertension,gastric perforation,perforation length,albumin level,CRP,PCT,creatinine,urea nitrogen level,lymphocyte count,NLR(>13.56)and PLR(>288.52)can all affect the grade of postoperative complications,among which the higher the NLR value,the greater the perforation long diameter,the lower the albumin level,the higher the grade of postoperative complications;2.age,perforation long diameter,platelet count,albumin level,CRP,PCT,creatinine,urea nitrogen,preoperative NLR and PLR can affect the occurrence of postoperative complications of ClavienDindo≥ grade 3.the preoperative NLR and perforation long diameter are independent risk factors for postoperative complications Clavien-Dindo≥grade 3,and high albumin level is its protective factor;3.albumin level can be used as a reference indicators to predict the occurrence of postoperative complications of grade 3 and above;4.preoperative NLR and PLR can be used as laboratory indicators to predict the occurrence of postoperative complications of grade 3 and above.