The Prognostic Significance of the Number of Neutrophils and Lymphocytes, C-Reactive Protein, and Procalcitonin in the Occurrence of Postoperative Infection

Abstract

 Introduction: The neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) are inflammatory markers whose dynamic increase plays a key role in the development of postoperative infections, which, as severe complications, have a major impact. An effective predictive marker could enable earlier treatment, reducing mortality, morbidity, and healthcare costs.

 Aim: To evaluate the prognostic value of the NLR, CRP, and PCT for postoperative infections at 24, 48, and 72 hours in cancer patients, and to assess the predictive role of absolute neutrophil (Ne) counts within the first 24 hours.

 Materials and Methods: This retrospective study at the Institute of Oncology of Vojvodina included 60 surgically treated cancer patients at the Clinic for Surgical Oncology. The NLR, CRP, PCT, and demographic and clinical data were analyzed.

 Results: NLR was a statistically significant predictor (p < 0.05). Ne, as part of this marker, increased as a first-line defense response, while lymphocytes were suppressed due to stress. Within the first 24 hours, Ne were not significant due to expected postoperative changes, but at 72 hours they were a significant predictor of infection (p < 0.05). CRP remained elevated during the infection, peaking within 72 hours, and was statistically significant (p < 0.05). PCT, as a dynamic marker with a faster rise and normalization, was not statistically significant for infection prediction (p > 0.05).

 Conclusion: Malignancy reduces the predictive value of initially high NLR, CRP, and PCT. CRP after 72 hours showed statistical significance for predicting infection, while PCT did not. The Ne count 24 hours postoperatively cannot reliably predict complications due to surgery-induced fluctuations. In the absence of more sensitive markers, NLR remains a practical and justified indicator.