Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Systemic Inflammatory Response and the Noble and Underwood (Nun) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery

Elke Van Daele
* ORCID logo ,
Hanne Vanommeslaeghe
,
Flo Decostere
,
Louise Beckers Perletti
,
Esther Beel
,
Yves Van Nieuwenhove
,
Wim Ceelen
ORCID logo ,
Piet Pattyn
Version 1 : Received: 4 January 2024 / Approved: 5 January 2024 / Online: 5 January 2024 (10:38:12 CET)

A peer-reviewed article of this Preprint also exists.

Van Daele, E.; Vanommeslaeghe, H.; Decostere, F.; Beckers Perletti, L.; Beel, E.; Van Nieuwenhove, Y.; Ceelen, W.; Pattyn, P. Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery. J. Clin. Med. 2024, 13, 826. Van Daele, E.; Vanommeslaeghe, H.; Decostere, F.; Beckers Perletti, L.; Beel, E.; Van Nieuwenhove, Y.; Ceelen, W.; Pattyn, P. Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery. J. Clin. Med. 2024, 13, 826.

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 centre observational cohort study included all esophagectomies from 2010-2020. C-reactive Protein (CRP), Albumin (Alb) and White cell count (WCC) were analyzed and Nun-scores calculated. Area under the curves (AUC) were used to assess their predictive accuracy. Seventy-four of the 668 patients (11%) developed an AL. CRP and the NUn-score proved to be good diagnostic accuracy tests on POD2 (CRP AUC:0,859; Nun-score AUC:0,869) and POD4 (CRP AUC:0,924; Nun-score AUC:0,948). A 182mg/L CRP cut-off on POD4 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 POD4 provide a high accuracy to predict AL after esophageal cancer surgery. Their high negative predictive value allows to select patients who can safely proceed with enhanced recovery protocols.

Keywords

NUn score; esophagectomy; anastomotic leakage; risk score; esophageal cancer; inflammatory biomarkers

Subject

Medicine and Pharmacology, Surgery

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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