PATIENTS AND METHODS
Study Design and Selection of Participants
The retrospective study was approved by the Ethics Committee of Beijing Friendship Hospital. Between January 2017 to December 2018, 154 patients without preoperative infection of the respiratory, digestive, or urinary tract underwent radical surgery for colorectal cancer and were enrolled in the study. And the operations were performed by the same group of surgeons. All the patients have signed written informed consent forms for their data to be used in the study and the data were kept confidential. This study was conducted in accordance with the Declaration of Helsinki.
We retrospectively examined the records maintained in our hospital’s database and extracted data regarding age, sex, body mass index, presence of chronic diseases, tumor location, neoadjuvant therapy, and pathological stage. We also collect data regarding the surgery, including the operation time, operation method, and intraoperative blood loss. Laboratory data collected in this study included preoperative albumin levels, preoperative mGPS, CAR on POD3, and poGPS on POD3.
Preoperative and postoperative inflammatory responses, respectively, were evaluated based on the mGPS and poGPS (Table 1), which represent widely validated and independent systemic inflammation-based prognostic scores.11 Many studies have reported that poGPS on PODs 3 and 4 is a predictor of infectious complications.12
Definition of Postoperative Complications
The severity of complications occurring within 30 days after surgery was graded based on the Clavien-Dindo classification.13 The main types of infectious complications included wound infection, urinary tract infection, pulmonary infection, abdominal pelvic infection, and sepsis. Surgical site infection was classified as superficial incision infection, deep incision infection, and organ infection, according to the guidelines issued by the Centers for Disease Control and Prevention in 2017.14
Statistical analyses were conducted using SPSS version 22.0 (IBM Corp., Armonk, NY, USA) and MedCalc version 18.2 (MedCalc Software bvba, Ostend, Belgium). Continuous data were expressed as mean ± standard deviation and compared between groups using the independent sample t-test. Categorical data were compared using the chi-square test or Fisher’s exact probability test. To identify independent risk factors for postoperative complications, variables showing significant association (P<0.05) with the outcome on univariate analysis were entered into the multiple logistic regression analysis, and the results were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Receiver operating characteristic curve analysis was used to estimate the initial predictive value of POD3 CAR, preoperative mGPS, and POD3 poGPS. The area under the curve (AUC) was calculated, and the sensitivity, selectivity, positive predictive value (PPV), and negative predictive value (NPV) at the optimal cutoff value (corresponding to the maximum value of the Jordan index) were obtained for each predictor. Relationships with P<0.05 were considered statistically significant.
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