The Change of Laboratory Tests Could Be Predictive Factors for Infection after McKeown Esophagogastrectomy

Abstract

Aim. To analyze whether the change of laboratory tests (postoperative day 1 (POD1) minus pre-operation) could be predictive factors for postoperative infection in patients who have undergone McKeown esophagogastrectomy. Methods. We retrospectively investigated the clinical data of 358 patients who have undergone McKeown esophagogastrectomy, and divided them into infection and noninfection groups. SPSS 22.0 software was performed for data analysis. Results. In the two groups, smoking status (66.7% vs. 42.3%; P = 0.014), male gender (86.1% vs. 72.0%; P < 0.001), hoarseness (23.6% vs. 8.7%; P < 0.001), poor coughing ability (51.4% vs. 9.1%; P < 0.001), the change of WBC count (5.59 ± 4.75 × 109/L vs. 4.51 ± 4.11 × 109/L; P = 0.05), the change of glucose (6.03 ± 3.97 g/L vs. 3.78 ± 3.18 g/L), the change of ALB (-12.83 ± 3.45 g/L vs.-10.69 ± 3.86 g/L), the change of CRE (0.17 ± 19.94 umol/L vs.-4.02 ± 15.40 umol/L, P = 0.047) were significantly different. These factors were assessed using logistic regression analysis, and factors with P ≤ 0.05 in the univariate analysis were entered into multivariate analysis based on the forward stepwise (conditional) method. Poor coughing ability (odds ratio [OR], 11.034, 95% confidence interval [CI], 5.358-22.724), smoking status (OR, 4.218; 95% CI, 2.110-8.431), the change of WBC count (OR, 1.079; 95% CI, 1.000-1.164), the change of serum ALB level (OR, 0.849; 95% CI, 0.772-0.935), and the change of blood glucose levels (OR, 1.237; 95% CI, 1.117-1.371) were determined as independent risk factors for postoperative infection. We established a scoring system based on these 5 factors, and the area under the curve for this predictive model was 0.843 (range, 0.793-0.894); the sensitivity, specificity, and cut-off score were 70.8%, 85.3%, and 2.500, respectively. Conclusion. Poor coughing ability, smoking habit, the high change of WBC and blood glucose levels, and low change of serum ALB levels can be used to predict the occurrence of postoperative infections among patients who have undergone McKeown esophagogastrectomy.