Value of postoperative C-reactive protein/albumin ratio in predicting short-term complication occurrence following radical gastrectomy for gastric cancer

Objective To investigate the value of postoperative C-reactive protein/albumin ratio (CAR) in predicting short-term complication occurrence following radical gastrectomy for gastric cancer. Methods Clinical data about 203 patients undergoing curative gastrectomy (R0) in the first medical center of Chinese PLA General Hospital from March 2016 to August 2018 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify clinical factors in predicting postoperative complications.The receiver-operating characteristic (ROC) curves were plotted to compare the accuracy of CAR and CRP in predicting early complications,and their cut-off values were calculated.According to the cut-off value of CAR,patients were divided into high CAR group and low CAR group.The incidence of mild (Clavien-Dindo classification gradesⅠandⅡ) and severe (Clavien-Dindo classification gradesⅢor above) complications as well as average postoperative hospital stay between the two groups were compared. Results Of all the patients,53 (26.1%) cases developed early postoperative complications.In univariate analysis,the correlations between early postoperative complications after radical gastrectomy and postoperative CRP (OR,7.737;95% CI,3.828 to 15.636;P<0.001),postoperative CAR (OR,8.757;95% CI,4.244 to 18.069;P<0.001) and surgical method (OR,2.110;95% CI,1.077 to 4.132;P=0.028) were statistically significant.Multivariate analysis identified postoperative CAR (OR,5.540;95% CI,1.021 to 30.075;P=0.047) was an independent risk factor for early postoperative complications.ROC curves showed that the accuracy of CAR in predicting early postoperative complications was a little higher than that of postoperative CRP (AUC:0.767 vs 0.752;sensitivity:0.741 vs 0.724;specificity:0.740 vs 0.707,Youden's index:0.481 vs 0.431).The optimal cut-off value of CAR was 2.83.Compared with the low CAR group (CAR<2.83,n=124),the high CAR group (CAR≥2.83,n=79) had a higher incidence of complications (50.6% vs 10.5%,P<0.001) and a greater median postoperative hospital stay 9(8,13) d vs 9(7,10) d,P=0.036. Conclusion Postoperative CAR is an independent predictor for short-term complication following radical gastrectomy for gastric cancer,and the diagnostic accuracy is a little higher compared to CRP alone.