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Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery

Elke Van Daele (UGent) , Hanne Vanommeslaeghe (UGent) , Flo Decostere, Louise Beckers Perletti (UGent) , Esther Beel, Yves Van Nieuwenhove (UGent) , Wim Ceelen (UGent) and Piet Pattyn (UGent)
(2024) JOURNAL OF CLINICAL MEDICINE. 13(3).
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Organization
Abstract
Anastomotic leakage (AL) remains the main cause of post-esophagectomy morbidity and mortality. Early detection can avoid sepsis and reduce morbidity and mortality. This study evaluates the diagnostic accuracy of the Nun score and its components as early detectors of AL. This single-center observational cohort study included all esophagectomies from 2010 to 2020. C-reactive protein (CRP), albumin (Alb), and white cell count (WCC) were analyzed and NUn scores were calculated. The area under the curve statistic (AUC) was used to assess their predictive accuracy. A total of 74 of the 668 patients (11%) developed an AL. CRP and the NUn-score proved to be good diagnostic accuracy tests on postoperative day (POD) 2 (CRP AUC: 0.859; NUn score AUC: 0.869) and POD 4 (CRP AUC: 0.924; NUn score AUC: 0.948). A 182 mg/L CRP cut-off on POD 4 yielded a 87% sensitivity, 88% specificity, a negative predictive value (NPV) of 98%, and a positive predictive value (PPV) of 47.7%. A NUn score cut-off > 10 resulted in 92% sensitivity, 95% specificity, 99% NPV, and 68% PPV. Albumin and WCC have limited value in the detection of post-esophagectomy AL. Elevated CRP and a high NUn score on POD 4 provide high accuracy in predicting AL after esophageal cancer surgery. Their high negative predictive value allows to select patients who can safely proceed with enhanced recovery protocols.
Keywords
inflammatory biomarkers, esophageal cancer, risk score, anastomotic leakage, esophagectomy, NUn score

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MLA
Van Daele, Elke, et al. “Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery.” JOURNAL OF CLINICAL MEDICINE, vol. 13, no. 3, 2024, doi:10.3390/jcm13030826.
APA
Van Daele, E., Vanommeslaeghe, H., Decostere, F., Beckers Perletti, L., Beel, E., Van Nieuwenhove, Y., … Pattyn, P. (2024). Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery. JOURNAL OF CLINICAL MEDICINE, 13(3). https://doi.org/10.3390/jcm13030826
Chicago author-date
Van Daele, Elke, Hanne Vanommeslaeghe, Flo Decostere, Louise Beckers Perletti, Esther Beel, Yves Van Nieuwenhove, Wim Ceelen, and Piet Pattyn. 2024. “Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery.” JOURNAL OF CLINICAL MEDICINE 13 (3). https://doi.org/10.3390/jcm13030826.
Chicago author-date (all authors)
Van Daele, Elke, Hanne Vanommeslaeghe, Flo Decostere, Louise Beckers Perletti, Esther Beel, Yves Van Nieuwenhove, Wim Ceelen, and Piet Pattyn. 2024. “Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery.” JOURNAL OF CLINICAL MEDICINE 13 (3). doi:10.3390/jcm13030826.
Vancouver
1.
Van Daele E, Vanommeslaeghe H, Decostere F, Beckers Perletti L, Beel E, Van Nieuwenhove Y, et al. Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery. JOURNAL OF CLINICAL MEDICINE. 2024;13(3).
IEEE
[1]
E. Van Daele et al., “Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery,” JOURNAL OF CLINICAL MEDICINE, vol. 13, no. 3, 2024.
@article{01HZF5SZT9334WT0YSCWKMW7XT,
  abstract     = {{Anastomotic leakage (AL) remains the main cause of post-esophagectomy morbidity and mortality. Early detection can avoid sepsis and reduce morbidity and mortality. This study evaluates the diagnostic accuracy of the Nun score and its components as early detectors of AL. This single-center observational cohort study included all esophagectomies from 2010 to 2020. C-reactive protein (CRP), albumin (Alb), and white cell count (WCC) were analyzed and NUn scores were calculated. The area under the curve statistic (AUC) was used to assess their predictive accuracy. A total of 74 of the 668 patients (11%) developed an AL. CRP and the NUn-score proved to be good diagnostic accuracy tests on postoperative day (POD) 2 (CRP AUC: 0.859; NUn score AUC: 0.869) and POD 4 (CRP AUC: 0.924; NUn score AUC: 0.948). A 182 mg/L CRP cut-off on POD 4 yielded a 87% sensitivity, 88% specificity, a negative predictive value (NPV) of 98%, and a positive predictive value (PPV) of 47.7%. A NUn score cut-off > 10 resulted in 92% sensitivity, 95% specificity, 99% NPV, and 68% PPV. Albumin and WCC have limited value in the detection of post-esophagectomy AL. Elevated CRP and a high NUn score on POD 4 provide high accuracy in predicting AL after esophageal cancer surgery. Their high negative predictive value allows to select patients who can safely proceed with enhanced recovery protocols.}},
  articleno    = {{826}},
  author       = {{Van Daele, Elke and Vanommeslaeghe, Hanne and Decostere, Flo and Beckers Perletti, Louise and Beel, Esther and Van Nieuwenhove, Yves and Ceelen, Wim and Pattyn, Piet}},
  issn         = {{2077-0383}},
  journal      = {{JOURNAL OF CLINICAL MEDICINE}},
  keywords     = {{inflammatory biomarkers,esophageal cancer,risk score,anastomotic leakage,esophagectomy,NUn score}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{12}},
  title        = {{Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery}},
  url          = {{http://doi.org/10.3390/jcm13030826}},
  volume       = {{13}},
  year         = {{2024}},
}
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