What question did this study set out to answer?

The study aims to evaluate how changes in inflammatory markers from blood tests can predict postoperative complications after laparoscopic sleeve gastrectomy.

March 29, 2026Open Access

Pan-Immune Inflammation Value in Detecting Perioperative Complications in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Prospective Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Morbid Obesity (n=112). Intervention: Pan-Immune Inflammation Value (PIV) vs. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Primary outcome: Prediction of early major postoperative complications (AUC 0.878, 95% CI 0.706-1.000, p=<0.001).

Key Result

Postoperative Pan-Immune Inflammation Value (PIV) accurately predicted early major complications following laparoscopic sleeve gastrectomy with an AUC of 0.878, outperforming NLR and PLR.

Key Points

The study aims to evaluate how changes in inflammatory markers from blood tests can predict postoperative complications after laparoscopic sleeve gastrectomy.
Conducted a prospective controlled study among patients scheduled for laparoscopic sleeve gastrectomy.
Collected preoperative and postoperative complete blood count parameters.
Calculated platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and pan-immune-inflammation value (PIV).
Divided patients into two groups based on complication occurrence and compared inflammatory markers.
Significant preoperative differences in white blood cell count, neutrophil count, and PIV between patients with and without complications.
Postoperative comparisons showed significant differences in WBC count, neutrophil count, platelet count, PLR, NLR, and PIV between groups.
PIV showed higher specificity and sensitivity compared to NLR and PLR for predicting major complications.

Study Design

Type

Cohort (n=112)

Multicenter

Yes

Structured PICO

Does the pan-immune-inflammation value (PIV) predict early major postoperative complications in patients undergoing laparoscopic sleeve gastrectomy?

Population

Patients scheduled for laparoscopic sleeve gastrectomy (LSG) due to morbid obesity (BMI ≥40 kg/m2 without associated medical problems or ≥35 kg/m2 with associated medical problems).

Intervention

Evaluation of pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) from complete blood count.

Comparator

Patients without perioperative complications vs patients with major perioperative complications (Clavien-Dindo Grade III, IV, or V).

Outcome

To assess whether the changes in preoperative and postoperative PIV, NLR, and PLR values could predict early major postoperative complications following LSG.surrogate

The pan-immune-inflammation value (PIV) calculated from routine complete blood counts provides high sensitivity and specificity for predicting early major postoperative complications following laparoscopic sleeve gastrectomy.

Main Result

Effect estimate: AUC 0.878 (95% CI 0.706-1.000)

p-value: p=<0.001

Limitations

Relatively small sample size of complicated cases
Exclusion of patients with comorbid conditions
Did not routinely use CRP, ESR, and procalcitonin levels for the follow-up period
Excluded minor complication cases (Clavien Dindo I-II)
CBC calculations used two different analyzers due to being a dual-center study

Abstract

Obesity is a significant health problem with increasing prevalence worldwide and is associated with numerous comorbidities. In this prospective controlled study, the relationship between changes in platelet-to-lymphocyte ratio(PLR), neutrophil-to-lymphocyte ratio(NLR), and pan-immune-inflammation value(PIV)-calculated from complete blood count parameters on the preoperative day and the first postoperative day-and early major surgical complications following laparoscopic sleeve gastrectomy(LSG) was investigated. Patients scheduled for LSG due to morbid obesity at the Department of General Surgery, Kahramanmaraş Sütçü İmam University, and Elazig Private Eastern Anatolia Hospital were prospectively included in the study. Preoperative and postoperative (24-hour) complete blood count (CBC) parameters were recorded, including white blood cell count (WBC), neutrophil count, lymphocyte count, monocyte count, and platelet count. PLR, NLR, and PIV were manually calculated. Patients were divided into two groups based on whether postoperative complications developed. In the preoperative period, significant differences were observed in WBC count, neutrophil count, and PIV values between patients with and without complications (p = 0.001, p < 0.001, and p < 0.001, respectively). In the postoperative period, significant differences were found between the two groups in WBC count, neutrophil count, platelet count, PLR, NLR, and PIV (p = 0.001, p < 0.001, p < 0.001, p = 0.047, p = 0.001, and p < 0.001, respectively). When preoperative and postoperative values were compared, NLR, PLR, and PIV showed a statistically significant increase (p = 0.001, p < 0.001, and p < 0.001, respectively). Our study demonstrated that among inflammatory markers calculated from CBC parameters, the PIV-assessing the overall immune-inflammatory response-provides higher specificity and sensitivity than NLR and PLR in predicting early postoperative major complications following LSG. The primary keypoint to assess whether the changes in preoperative and postoperative PIV, NLR, and PLR values could predict early major postoperative complications following LSG. The Secondary keypoint included evaluation of perioperative major complication rates, reoperation rates, and mortality rates.

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