Key result
Novel biomarker model predicts post-bariatric surgery weight regain with ~0.81 validation AUC.
Observational (n=394)
Open-label
No
Effect estimate: AUC 0.852 (95% CI 0.795-0.910)
Preoperative levels of systemic immune-inflammation index, LDL-C, ferritin, and HDL-C can effectively predict postoperative weight regain within 12 months after bariatric surgery.
May aid preoperative risk stratification for post-bariatric weight regain; hypothesis-generating and requires prospective validation before clinical use.
OBJECTIVE: Postoperative weight regain remains a challenge after bariatric surgery and affects long-term outcomes. This study aimed to develop a clinical model to predict weight regain within 12 months, prior to surgery by using preoperative inflammatory, metabolic, and ferritin as biomarkers. SUBJECTS AND METHODS: This retrospective observational study included 394 patients with obesity who underwent bariatric surgery (2020-2023), including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients were divided into a training set (70%, n = 276) and a validation set (30%, n = 118) using a random number table. Weight regain was defined as a ≥ 10% increase from the postoperative nadir (median time to regain: 8.2 months). Key variables included peripheral blood inflammatory markers [systemic immune-inflammation index (SII, calculated as platelet count × neutrophil count/lymphocyte count), neutrophil-to-lymphocyte ratio (NLR)], glycolipid metabolism indicators [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)], and ferritin levels. Multivariate logistic regression was used to identify independent predictive variables, and the nomogram model was validated via calibration, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA). RESULTS: The weight regain rate was 19.9% (55/276) in the training set. Independent predictive variables included elevated SII (OR=1.004; 95% CI = 1.000-1.007), LDL-C (OR = 1.873; 95% CI = 1.054-3.329), ferritin (OR = 1.005; 95% CI = 1.003-1.008), and reduced HDL-C (OR = 0.103; 95% CI = 0.013-0.844) (all P < 0.05). The model showed strong discrimination (training AUC = 0.852, 95% CI = 0.795-0.910; validation AUC = 0.812, 95% CI = 0.709-0.915) and good calibration (Hosmer-Lemeshow P > 0.05). DCA confirmed the model's clinical utility across threshold probabilities. CONCLUSION: Preoperative SII, LDL-C, ferritin, and HDL-C levels effectively predict postoperative weight regain. Early monitoring of these biomarkers may guide personalized interventions to improve long-term outcomes.
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Liu et al. (2026) conducted an observational in Obesity (postoperative weight regain) (n=394). Preoperative biomarkers (SII, LDL-C, ferritin, HDL-C) vs. Patients without weight regain was evaluated on Postoperative weight regain within 12 months (≥ 10% increase from postoperative nadir) (AUC 0.852, 95% CI 0.795-0.910). A clinical prediction model incorporating preoperative systemic immune-inflammation index, LDL-C, ferritin, and HDL-C levels effectively predicted weight regain within 12 months after bariatric surgery, demonstrating a training AUC of 0.852 and a validation AUC of 0.812.
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