Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients

Table 1 Correlation of anastomotic leakage with clinical and laboratorial parameters in middle and low rectal cancer patients undergoing laparoscopic operation

Characteristics	AL (n = 67)	Non-AL (n = 493)	χ2	P value
Gender
Male	37	250	0.481	0.488
Female	30	243
Age
< 60	19	181	1.794	0.180
≥ 60	48	312
BMI (kg/m2)
< 24	57	395	0.930	0.335
≥ 24	10	98
Hypertension
Yes	21	114	2.178	0.140
No	46	379
Diabetes
Yes	12	87	0.003	0.958
No	55	406
Smoking history
Yes	19	68	9.536	0.002
No	48	425
Drinking history
Yes	23	178	0.081	0.776
No	44	315
Preoperative intestinal obstruction
Yes	11	40	4.914	0.027
No	56	453
Preventive stoma
Yes	7	32	1.425	0.233
No	60	461
Surgical time (minutes)
< 180	39	417	27.133	< 0.001
≥ 180	28	76
Intraoperative bleeding (mL)
< 300	58	461	4.189	0.041
≥ 300	9	32
Neoadjuvant treatment
Yes	5	43	0.119	0.730
No	62	450
Tumor size (cm)
< 5	61	439	0.246	0.620
≥ 5	6	54
TNM stage
I	50	397	1.454	0.483
II	12	72
III	5	24
Tumor location (cm)
< 7	30	159	4.138	0.042
≥ 7	37	334
WBC (× 109/L)
< 10	50	395	1.091	0.296
≥ 10	17	98
Hb (g/L)
< 130 (male) or 120 (female)	8	56	0.033	0.855
≥ 130 (male) or 120 (female)	59	437
PLT (× 109/L)
< 400	57	381	2.102	0.147
≥ 400	10	112
CRP (mg/L)
< 10	48	385	1.400	0.237
≥ 10	19	108

AL: Anastomotic leakage; BMI: Body mass index; TNM: Tumor node metastasis; WBC: White blood cell; Hb: Hemoglobin; PLT: Platelet; CRP: C-reactive protein.

Table 2 Comparison of preoperative serum nutritional factors between anastomotic leakage patients and non-anastomotic leakage patients

Group	n	Serum nutritional factors (mean ± SD)
		PA (mg/L)	ALB (g/L)	TRF (g/L)
AL	67	245.74 ± 55.18	32.19 ± 4.87	2.24 ± 0.32
Non-AL	493	331.83 ± 67.12	38.74 ± 5.62	2.89 ± 0.54
t		10.045	9.086	9.621
P value		< 0.001	< 0.001	< 0.001

AL: Anastomotic leakage; PA: Prealbumin; ALB: Albumin; TRF: Transferrin.

Table 3 Comparison of preoperative serum nutritional factors among different grades of anastomotic leakage patients

Grade	n	Serum nutritional factors (mean ± SD)
		PA (mg/L)	ALB (g/L)	TRF (g/L)
Grade A	30	312.04 ± 56.61	36.81 ± 5.29	2.76 ± 0.41
Grade B	26	243.19 ± 54.28	30.72 ± 4.18	2.27 ± 0.34
Grade C	11	207.18 ± 43.66	22.60 ± 3.76	1.98 ± 0.27
F		19.801	39.323	23.173
P value		< 0.001	< 0.001	< 0.001

PA: Prealbumin; ALB: Albumin; TRF: Transferrin.

Table 4 Univariate and multivariate logistic regression analysis of risk factors for anastomotic leakage

Factors	Reference	Univariate			Multivariate
		OR	95%CI	P value	OR	95%CI	P value
PA	Continuous variable	1.721	1.271-2.198	0.021	2.621	1.582-3.812	0.012
ALB	Continuous variable	1.594	1.165-2.063	0.017	3.982	1.927-4.887	0.024
TRF	Continuous variable	1.982	1.366-2.598	0.030	2.109	1.162-2.981	0.031
Gender	0 = male, 1 = female	0.982	0.764-1.175	0.281	/	/	/
Age	0 = < 60, 1 = ≥ 60	1.021	0.835-1.284	0.473	/	/	/
BMI	0 = < 24 kg/m2, 1 = ≥ 24 kg/m2	0.894	0.712-1.092	0.501	/	/	/
Hypertension	0 = No, 1 = Yes	1.123	0.902-1.351	0.124	/	/	/
Diabetes	0 = No, 1 = Yes	1.076	0.863-1.376	0.374	/	/	/
Smoking history	0 = No, 1 = Yes	1.369	1.064-1.517	0.032	1.170	1.086-1.375	0.088
Drinking history	0 = No, 1 = Yes	0.994	0.704-1.328	0.584	/	/	/
Preoperative intestinal obstruction	0 = No, 1 = Yes	2.083	1.695-3.206	0.028	0.927	0.786-1.159	0.617
Preventive stoma	0 = No, 1 = Yes	1.046	0.903-1.254	0.438	/	/	/
Surgical time	0 = < 180 minutes, 1 = ≥ 180 minutes	1.098	0.916-1.328	0.330	/	/	/
Intraoperative bleeding	0 = < 300 mL, 1 = ≥ 300 mL	1.436	1.102-1.763	0.021	4.182	2.108-5.482	0.009
Neoadjuvant treatment	0 = No, 1 = Yes	1.121	0.921-1.328	0.287	/	/	/
Tumor size	0 = < 5 cm, 1 = ≥ 5 cm	0.899	0.711-1.197	0.319	/	/	/
TNM stage	0 = I, 1 = II or III	0.876	0.702-1.354	0.437	/	/	/
Tumor location	0 = ≥ 7 cm, 1 = < 7 cm	1.498	1.073-2.019	0.012	3.124	1.779-4.215	0.016
WBC	0 = < 10 × 109/L, 1 = ≥ 10 × 109/L	0.926	0.804-1.154	0.572	/	/	/
PLT	0 = < 400 × 109/L, 1 = ≥ 400 × 109/L	0.957	0.726-1.368	0.439	/	/	/
CRP	0 = < 10 mg/L, 1 = ≥ 10 mg/L	1.051	0.804-1.328	0.265	/	/	/

OR: Odds ratio; CI: Confidence interval; PA: Prealbumin; ALB: Albumin; TRF: Transferrin; BMI: Body mass index; TNM: Tumor node metastasis; WBC: White blood cell; Hb: Hemoglobin; PLT: Platelet; CRP: C-reactive protein.