Authors: Goh, Jason C. H. et al.
Canadian Journal of Anesthesia
Single-centre retrospective cohort study, Singapore General Hospital, 2017–2020.
This large retrospective analysis examined whether simple inflammatory markers derived from the complete blood count—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW)—can predict short-term mortality and intensive care unit (ICU) stay in adult perioperative patients.
The study included 53,375 surgical patients aged 21 years or older. Preoperative blood counts were used to calculate NLR, PLR, and RDW. Outcomes assessed were 30-day mortality and ICU stay longer than 24 hours. Using multivariable logistic regression and receiver operating characteristic (ROC) analysis, the investigators found that all three markers correlated with postoperative morbidity and mortality, but RDW and NLR were the strongest independent predictors.
On multivariable analysis, RDW had an odds ratio (OR) of 2.69 (95% CI 2.10–3.44), NLR an OR of 2.40 (95% CI 1.89–3.06), and PLR an OR of 1.91 (95% CI 1.50–2.43). When combined, RDW (OR 2.61, 95% CI 2.04–3.33) and NLR (OR 2.07, 95% CI 1.58–2.72) remained statistically significant, and the model’s predictive accuracy (AUROC) improved significantly compared with models excluding inflammatory markers.
The authors conclude that elevated RDW and NLR—simple, routinely available indices—are independent predictors of 30-day mortality and prolonged ICU stay in surgical patients. These findings suggest that preoperative inflammatory status reflects underlying physiologic vulnerability. However, further external validation is needed before routine clinical adoption.
What You Should Know
• High RDW and NLR values from routine CBCs predict increased risk of postoperative mortality and prolonged ICU stay.
• These markers reflect systemic inflammation and may identify patients with higher perioperative vulnerability.
• Adding inflammatory indices to perioperative risk models improves prognostic accuracy.
• While promising, the findings require validation in broader, multicenter populations before influencing clinical decision-making.
Thank you for reading this summary of the Singapore General Hospital study in Canadian Journal of Anesthesia on inflammatory indices and surgical outcomes.