TY - JOUR
TI - Diagnostic value of post-operative platelet-to-white blood cell ratio
after splenectomy in patients with advanced ovarian cancer
AU - Lathouras, Konstantinos
AU - Panagakis, Georgios
AU - Bowden, Sarah Joanne
AU - and Saliaris, Konstantinos
AU - Saso, Srdjan
AU - Haidopoulos, Dimitrios
AU - and Fotopoulou, Christina
JO - International Journal of Gynecological Cancer
PY - 2019
VL - 29
TODO - 8
SP - 1292-1297
PB - BMJ Publishing Group
SN - 1048-891X, 1525-1438
TODO - 10.1136/ijgc-2019-000712
TODO - cytoreduction; ovarian cancer; platelet-to-white blood cell ratio (PC;
WCC-ratio); sepsis; splenectomy; surgery
TODO - Introduction Splenectomy-induced thrombocytosis and leukocytosis may
obscure the early diagnosis of post-operative infection or sepsis. In
trauma patients after splenectomy, a platelet-to-white blood cell ratio
of Objective To determine whether the platelet-to-white blood cell ratio
can be applied to differentiate between reactive post-operative changes
and latent infection. Methods All consecutive patients with ovarian
cancer who underwent splenectomy between January 2013 and October 2018
in two large European gynecological cancer centers were retrospectively
evaluated. Main outcome measures were white blood cell count, platelet
count, and platelet-to-white blood cell ratio on post-operative days 1,
5, and 7. These were correlated with surgical outcome and morbidity
according to the Clavien-Dindo classification. A binomial logistic
regression was applied to assess the predictive value of day 5
platelet-to-white blood cell ratio, white blood cell count, and platelet
count for predicting grade III post-operative sepsis. Results
Ninety-five patients with ovarian cancer (mean age 54 years, range
18-75) were identified. Seventeen patients (17.9%) developed a grade
III post-operative sepsis. In all post-operative patients, mean white
blood cell count on day 5 decreased (from 15.4x10(3)/mu L to
11.4x10(3)/mu L), while the mean platelet count rose (from
260.7x10(3)/mu L to 385.3x10(3)/mu L). A high platelet count
(>313x10(3)/mu L) failed to show any predictive value (OR=0.94; 95% CI
0.30 to 3.0; p=0.921). A low platelet-to-white blood cell ratio (<26)
(OR=3.49; 95% CI 1.18 to 10.32; p=0.0241) and high white blood cell
count (>14.5x10(3)/mu L) on day 5 (OR=11.0; 95% CI 3.3 to 36.2;
p<0.001) were significant for predicting sepsis. Despite a significant
OR, the sensitivity and specificity were low; day 5 platelet-to-white
blood cell ratio at a cut-off point of 26 achieved a sensitivity of 72%
and specificity of 53% (area under the curve 0.637, 95% CI 0.480 to
0.796) in predicting grade III post-operative sepsis. Conclusions
Platelet-to-white blood cell ratio after cytoreductive surgery for
ovarian cancer with splenectomy does not appear to have a strong
predictive value in differentiating between sepsis and reactive
splenectomy-induced changes. Leukocytosis, in combination with clinical
assessment, may remain the most useful tool for prediction of sepsis
after cytoreductive surgery with splenectomy.
ER -