PTU-140 Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly

Introduction Accurate prediction of outcome after emergency surgery in the elderly patient may assist decision making. However, certain scoring systems require post-operative data (eg, P-POSSUM) while others have failed to gain widespread use (eg, Surgical risk score). Recent reports have suggested that C reactive protein (CRP) and the neutrophil lymphocyte (N/L ratio) ratio may predict surgical outcome. Methods A retrospective review of consecutive unselected patients aged 80 years or over undergoing emergency abdominal surgery over a 22-month period was performed. Univariate, multivariate and recursive analyses were performed and findings validated using an independent data-set. Results 88 patients were identified, median age 84 years. 30-day mortality was 31%, 6-month mortality 43% and 12-month mortality 50%. Univariate analysis revealed age, N/L ratio, CRP, midline laparotomy, ASA and surgical risk score to predict outcome at set time points. Using a recursive approach N/L ratio>22 (p=0.0018) best predicted 30-day outcome. On multivariate analysis, N/L ratio was an independent predictor of 30-day outcome (p=0.004, df=1, χ 2 =8.144) while CRP failed to predict outcome at any time point. In an independent dataset (n=84), N/L ratio was an independent prognostic factor at 30 days (p=0.001, df=2, χ 2 =15.071), 6 months (p 2 =12.536) and 12 months (p=0.001, df=1 χ 2 =10.27). Conclusion We suggest that N/L is an easily calculable pre-operative measure that may have utility in the prediction of outcome after emergency abdominal surgery in the elderly. Further work to validate this measure in a larger, prospective setting and determine why N/L ratio predicts outcome is necessary. Competing interests None declared.