الفهرس 
Role of Neutrophil to Lymphocyte Ratio in Prediction of Early Post-operative Complications after Surgery for Intestinal Obstruction
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Abstract
Background: Gastrointestinal surgery is associated with a substantial risk of postoperative
complications, reported in almost 50% of cases after major operations. Not only detrimental to
patients, they also induce a significant increase in costs, a timely concern while healthcare
expenditures need to be controlled.
Aim of the work: This study was designed to determine the value of a simple non-invasive
parameter - the neutrophil to lymphocyte ratio (NLR), in the first day post-operative in the
prediction of early postoperative complications following intestinal obstruction surgery.
Patients and Methods: This study includes 170 consecutive patients complaining of intestinal
obstruction due to different primary causes and not having a previous abdominal surgery. The
number of the male patients in the study is 97 patients (57.1%), while the females are 73
(42.9%). The age of the patients range in between 16 to 70 with the mean age 53.16 ±2.57 years
old.
Results: The NLR value in the preoperative investigation ranging between 2 and 25 with average
value of 6.71±8.7 The NLR which was done in the first postoperative day is ranging between 0.6
and 31.3 with average value of 6.77±4.75. Although the NLR increase post operatively but It was
found that there is insignificant difference between the NLR before and after 24 hours
postoperative. The NLR of the complicated patients was ranged between 1.61 to 31.3 with
average value of 8.65±4.83, while that of non-complicated cases has a range of 0.6 to 7.63 with
an average of 3.985±1.47. The difference of the mean of NLR in first post-operative day between
complicated and non-complicated cases is highly significant. ROC curve analysis of NLR
suggested that a cut off value of 5.01 was the optimal value for predicting complications, with
an area under the curve of 0.873. This cut off point produced sensitivity of 84.61% (95%CI
0.7545-0.9133) and specificity of 78.37%. (95%CI 0.6728-0.8711). The overall model quality is
good as it is equal to 0.82.
Conclusion: NLR is a good and cheap easily available investigation that can predict postoperative
early complication after operation for intestinal obstruction. It has a good sensitivity and
specificity in prediction of early postoperative complications. A further studies that compare
other cheap and easily available biomarkers with NLR in prediction of postoperative
complications is required.