The Impact of the Preoperative Red Blood Cell Distribution Width Value on Weight Loss Estimation After Sleeve Gastrectomy (original) (raw)
Related papers
2020
Background: The aim of this study was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG). Methods: 15 obese patients were enrolled in this study. They consisted of 5 males and 10 females: mean body weight (BW) 127.5kg; mean body mass index (BMI) 46.7kg/m2. 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined. Results: The BMI, %EWL and %TWL at 1 year post-operative were 35.1 kg/m2, 46.3% and 26.2%, respectively. Improvements were also evident in the diabetes at 1 year post-operative: complete remission (CR) (No medication and hemoglobin A1c (HbA1c) HbA1c<6.0%) 40%, PR (HbA1c<6.5) 20%; and (decrease of anti diabetic drug and HbA1c<7.0%) 40%. Comparing pre-operative NLR in %EWL<50% and >50% in one (1) year post-operative, <50% was 2.64 and >50% was 2.03 (p<0.05). The NLR in CR and partial remission (PR) was signi cantly lower than that in improved (Improve) (2.22 vs 3.27, p<0.05). Conclusions: The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG.
Clinical biochemistry, 2017
C-reactive protein (CRP) is often elevated in patients living with severe obesity (BMI≥35kg/m2). However, there is limited information on how CRP, and other inflammation responsive biomarkers, change in response to weight loss following laparoscopic sleeve gastrectomy (LSG). We studied how CRP, ferritin and albumin change following LSG surgery in relation to obesity, metabolic syndrome (MetS) ATPIII risk components and diabetes mellitus (DM). Laboratory parameters (including CRP) were examined in 197 patients prior to LSG, and at 6, 12, 18 and 24months. Changes in laboratory parameters, and laboratory investigations, were also examined in a 125 patient subgroup at both pre-LSG and at the 12month follow-up visit. All patients had BMI≥35kg/m2. CRP levels positively correlated with BMI (r=0.171, p=0.016) and alkaline phosphatase (ALP; r=0.309; P<0.001), but negatively correlated with alanine aminotransferase (ALT; r=-0.260; P<0.001) and albumin (r=-0.358; P<0.001). LSG signifi...
Obesity is a growing public health problem worldwide. Bariatric surgical procedures achieve the most sustainable and efficacious outcomes in the treatment of morbid obesity. However, little is known about the underlying molecular pathways modulated by these surgical interventions. Since leptin resistance is implicated in the pathogenesis of obesity, we herein report the effects of laparoscopic sleeve gastrectomy (LSG) on the serum levels of leptin and leptin receptor, in addition to its overall effect on leptin resistance. This was an interventional and follow-up clinical study. In the first part, patients attending the general surgery outpatient clinics at our university hospital were first stratified according to their Body-Mass Index (BMI) into cases (n = 38) with BMI ≥ 35 who were scheduled to undergo LSG, and controls (n = 75) with a normal BMI. Serum leptin and leptin receptor levels were measured by sandwich ELISA technique. A leptin resistance index was estimated by adjusting leptin to BMI ratio to leptin receptor concentration. In the second part of the study, cases who underwent LSG were followed up one year postoperatively to assess their BMI and serum leptin and leptin receptor levels. Leptin to BMI ratio was significantly higher, while serum leptin receptor was significantly lower, in obese patients compared to controls. This translated into a significantly higher leptin resistance index in obese patients. LSG resulted in a significant reduction of BMI, leptin to BMI ratio, and leptin resistance index, as it significantly increased leptin receptor levels. In conclusion, LSG showed significant decrease in leptin resistance in obese patients after one year. Further studies are needed to determine the clinical impact of this finding on LSG outcomes.
Impact of Preoperative Weight Loss on Postoperative Weight Loss After Sleeve Gastrectomy
Bariatric surgical practice and patient care, 2018
Clinical observations in developing countries and experimental studies in animals suggest that preoperative weight loss adversely affects postoperative morbidity. Since it is not clear whether these findings can be applied to surgical series in European countries, we have studied 106 surgically-treated patients with inflammatory bowel disease. Patients were divided into three groups according to the degree of preoperative weight loss. The groups were well matched in all other respects. Postoperative morbidity was monitored independently. The outcome in all three groups was similar so that in these patients, at least, preoperative weight loss did not adversely affect the postoperative outcome.
P14: Influence of obesity and bariatric surgery on C-reactive protein and white blood cell count
Surgery for Obesity and Related Diseases, 2008
Background: Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein(CRP) and white blood cell count(WBC). The clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients. Methods: From December 1,2001 to January 31,2006,of 640(442 females and 198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year's follow-up were examined. Results: Of the patients, 476 (74.4%)had elevated CRP and 100 (15.6%)had elevated WBC at pre-operative study. CRP and WBC were significantly related and both increased with increasing BMI. CRP is also increased with increasing waist, glucose , hemoglobin, albumin,Ca,insulin, C-peptide, and metabolic syndrome(MS) while WBC is increased with MS but decreased with increasing age. Multivariate analysis confirmed glucose and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery. Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8Ϯ11.7kg vs. 17.3Ϯ10.8kg, pϭ0.000) and achieved a lower BMI (27.8Ϯ4.6 vs. 35.0 Ϯ5.5, pϭ0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated CRP 1 year after surgery (95.9% vs. 84.5%, pϭ0.169) and WBC (99.4% vs. 98.3%, pϭ0.323). Conclusion: Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately.
The role of C-reactive protein after surgery for obesity and metabolic disorders
Surgery for Obesity and Related Diseases
Background: C-reactive protein (CRP) rise might be different in patients with obesity due to chronic inflammation. Objectives: The aim was to analyze postoperative CRP rise and its role as an early prognostic marker of infectious complications. Setting: Center of maximum care in Germany. Methods: Patients who underwent laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic one-anastomosis gastric bypass as primary treatment for severe obesity were included. Serum CRP and leukocyte count were measured preoperatively, on postoperative days (POD) 1 and 4 and were analyzed regarding sex, body mass index, waist circumference, obesity-associated diseases, laboratory measurements (glycosylated hemoglobin, triglycerides, cholesterol), surgical procedure, infectious complications, and infectious with anastomotic leakage. Results: Four hundred seventy-one patients underwent surgery. Postoperative CRP rise was similar across sexes but lower in the super-super obese group (P , .05) and higher in the gastric bypass groups (P ,.05). Linear regression model showed, that the higher preoperative value of waist circumference, the higher the preoperative CRP (beta value: .159, P 5 .006) and the lower the postoperative CRP rise on POD1 (beta value: 2.171, P 5 .004) and 4 (beta value: 2.170, P 5 .003). Only in the laparoscopic one-anastomosis gastric bypass group did a higher glycosylated hemoglobin predict a higher postoperative CRP rise (POD1: beta value: .434, P 5 .012; POD4: beta value: .513, P 5 .006). Fourteen patients (3%) developed infections, 7 of whom (1.5%) had anastomotic leakage. Leukocyte count was no predictor of infectious complications. The cutoff for CRP was 80.5 mg/L (POD1) and 164 mg/L (POD4), with 57.1% and 85.7% sensitivity and 97.9% and 99.6% specificity for anastomotic leakage. Conclusion: Standard postoperative CRP rises less in patients with higher waist circumference and super-super obesity, but more after gastric bypass procedures. CRP but not leukocyte count predicts early anastomotic healing after obesity surgery. These findings should be considered when interpreting CRP values in the routine clinical setting.
Cirugía Española (English Edition), 2020
Introduction: Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. Methods: Retrospective cohort including patients !18 years old with BMI ! 35 Kg/m 2 , who underwent primary sleeve gastrectomy between 2014-2017 at the Avendañ o Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% !60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. Results: Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed 0.29% less EWL% per each extra year of life (P = .019), and 0.93% more EWL% per each extra HOMA-IR point (P = .004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P = .050), and 2% more chance of success per each additional HOMA-IR point (P = .038). Conclusions: There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.
The impact of selected factors on parameters of weight loss after sleeve gastrectomy
Videosurgery and Other Miniinvasive Techniques, 2016
Introduction: The effectiveness of sleeve gastrectomy has been confirmed in many studies. The impact of individual factors on the parameters of weight loss is still not clear. Aim: To identify important factors affecting the parameters of weight loss after sleeve gastrectomy. Material and methods: The impact of prognostic factors and postoperative care components on body mass index (BMI) and percentage excess weight loss (%EWL) was assessed in a group of 100 consecutive patients who underwent laparoscopic sleeve gastrectomy. Results: The baseline BMI and body mass in patients with BMI < 30 kg/m 2 and BMI ≥ 30 kg/m 2 12 months after sur
Surgical Endoscopy, 2014
Background Previous studies show that 'poor responders' to Roux-en-Y gastric bypass (RYGBP) may be identified on the basis of early postoperative weight loss. Early identification of poor responders could allow earlier provision of postoperative behavioural and/or intensive lifestyle interventions and enhance their maximal weight loss. Our aim was to investigate whether early postoperative weight loss predicts the maximal weight loss response after RYGBP and sleeve gastrectomy (SG). Methods We undertook a retrospective cross-sectional study of 1,456 adults who underwent either RYGBP (n = 918) or SG (n = 538) as a primary procedure in one of two European centres. Postoperative weight loss was expressed as weight loss velocity (WLV) and percentage weight loss. Linear regression analyses were performed to determine the association of early postoperative weight loss with maximal %WL, including adjustment for baseline variables.
Videosurgery and Other Miniinvasive Techniques, 2015
Introduction: Obesity increases production of adipose tissue-derived proteins, such as tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6). Also there are elevated levels of C-reactive protein (CRP) and IL-6, CD8, and CD4, indicating chronic subclinical inflammation. Since obesity represents a serious risk factor in several metabolic diseases, identifying the status of carbohydrate antigen-125 (CA-125) would further link obesity and tumors. Aim: To examine the effect of weight loss by laparoscopic sleeve gastrectomy (LSG) on plasma CRP, lipid profiles and CA-125 level in morbidly obese patients. Material and methods: This prospective study was conducted in the Surgery Department, Fayoum University Hospital, between August 2013 and September 2015. To assess the effect of excess weight loss following this operation CRP, lipid profile and CA-125 were measured before and 12 months after the LSG operation for weight loss. The study included 30 cases of morbidly obese patients: 30 (100%) females aged 23-55 years who were considered clinically obese with a mean body mass index of 42.71 ±4.3 (38-46) kg/m 2 and mean age of 40.3 ±8.5 (23-55) years. The National Institute of Health (NIH) inclusion criteria for bariatric surgery were used. Results: A mean weight loss of 29.30% decreased plasma CRP, triglycerides, total cholesterol and low-density lipoprotein cholesterol (HDL cholesterol), CA-125 level and increased high-density lipoprotein cholesterol (HDL cholesterol) The percentage weight loss was significantly associated with changes in plasma CRP, triglycerides, total cholesterol, total HDL cholesterol and CA-125. Conclusions: Weight loss by LSG improves inflammation, dyslipidemia and CA-125 level.