Predictive Value of Inflammatory Biomarkers, Nutritional Status and Vitamin D in Postoperative Outcomes After Sleeve Gastrectomy

Abstract

Purpose: This study aimed to assess how well preoperative systemic inflammation markers, the prognostic nutritional index (PNI), and blood vitamin D [25(OH)D] levels predict short-term postsurgical issues following laparoscopic sleeve gastrectomy (LSG).Materials and Methods: The analysis of the data of 383 LSG patients was performed. Preoperative data consisted of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), PNI, and 25(OH)D measurements. To find independent complication predictors, we ran univariate and multivariate logistic regressions. Because of multicollinearity among inflammatory indices, the final model retained only NLR. Evaluation of the predictive accuracy and clinical usefulness was carried out with the receiver operating characteristic (ROC) and decision curve analyses.Results: Twenty-three patients (6.0%) developed early complications. On univariate analysis, elevated NLR, PLR, and SII, as well as reduced PNI and 25(OH)D levels, correlated with complication occurrence. Multivariate analysis identified NLR (OR = 1.85, 95% CI: 1.22–2.81, p=0.004) and male sex (OR = 2.45, 95% CI: 1.10–5.46, p=0.028) as independent predictors; vitamin D showed no such association (p=0.19). ROC analysis revealed NLR as the strongest predictor (AUC = 0.84), followed by PLR (AUC = 0.78); PNI and vitamin D displayed only modest discriminative ability. The multivariable model showed good performance (AUC = 0.86).Conclusion: Preoperative NLR and male sex independently predict early postoperative complications after LSG. NLR is a simple biomarker that may enhance preoperative risk assessment. Although PNI and 25(OH)D were not independent predictors, they remain clinically relevant for patient optimization.