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Observational Study
. 2017 Jan;96(3):e5895.
doi: 10.1097/MD.0000000000005895.

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents: A retrospective observational study

Hao Jin  1 , Qing Pang, Huichun Liu, Zongkuang Li, Yong Wang, Yimin Lu, Lei Zhou, Hongtao Pan, Wei Huang
Affiliations
Observational Study

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents: A retrospective observational study

Hao Jin et al. Medicine (Baltimore). 2017 Jan.

Abstract

We aimed to assess the therapeutic effect of reimplantation of biliary metal stents by percutaneous transhepatic cholangial drainage (PTCD) in patients with recurrent malignant obstructive jaundice (MOJ). Furthermore, we explored the prognostic value of inflammation-based markers in these patients.We reviewed 33 cases of recurrent MOJ after implantation of biliary metal stents by PTCD, all of which underwent reimplantation of stents under digital subtraction angiography guidance. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were compared between before and after reimplantation (1 week, 1 month, and 3 months postoperatively). Preoperative clinical data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (SII, neutrophil × platelets/ lymphocyte), platelets-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was overall survival (OS), which was estimated by the Kaplan-Meier method and Cox regression analysis.The levels of ALT, AST, total bilirubin, and direct bilirubin significantly reduced after the reimplantation operation. During a median follow-up time of 10 months, 18 (54.5%) patients died. Gender, albumin, SII, PLR, NLR, and MLR were found to be associated with OS by the log-rank test and univariate analysis. Multivariate Cox analysis identified elevated levels of SII and PLR as significant factors for predicting poor OS.Reimplantation is clinically feasible in patients with recurrent MOJ after implantation of biliary metal stents. SII and PLR are independent, useful inflammation-based prognostic models for predicting outcomes in these patients.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The operation progress of reimplantation of biliary metal stents by PTCD. (A) Cholangiography of PTCD indicating primary stent obstruction. (B) Cholangiographic catheter passes the stent into the intestine. (C) Stent re-implantation. (D) Dilated balloon expanding the implanted stent. PTCD = percutaneous transhepatic cholangial drainage.
Figure 2
Figure 2
Comparison of patients’ liver function between preoperation and postoperation. When compared to the preoperative, the levels of ALT (A), AST (B), TBIL (C), and DBIL (D) significantly improved at 1 week, 1 month, and 3 months postoperatively (∗P < 0.05). ALT = alanine aminotransferase, AST = aspartate aminotransferase, DBIL = direct bilirubin, TBIL total serum bilirubin.
Figure 3
Figure 3
The survival curve of patients after reimplantation of biliary metal stents.
Figure 4
Figure 4
Cumulative survival curves of patients stratified according to the SII (A), PLR (B), NLR (C), and MLR (D). MLR = monocyte-to-lymphocyte ratio, NLR = neutrophil-to-lymphocyte ratio, PLR = platelets-to-lymphocyte ratio, SII = systemic immune-inflammation index.
Figure 5
Figure 5
Forest plot based on the results of multivariate analysis of the factors associated with overall survival of recurrent MOJ patients. MOJ = malignant obstructive jaundice.
See this image and copyright information in PMC

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