Prognostic Value of C-reactive Protein and Neutrophil-to-Lymphocyte Ratio in Predicting Postoperative Infections After Gastrointestinal Surgery: A Meta-Analysis

Postoperative infectious complications remain a significant cause of morbidity following gastrointestinal (GI) surgeries, necessitating early and reliable prognostic markers to guide timely intervention. This meta-analysis aimed to evaluate the predictive value of two widely available inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), in forecasting postoperative infections in patients undergoing GI surgery. A systematic search of databases and trial registries was conducted, and eight studies meeting the inclusion criteria were analyzed. A total of 2,020 patients were included across these studies, covering various GI surgical procedures such as gastric resection, bile duct repair, appendectomy, and Crohn's disease surgery. The meta-analysis revealed that elevated NLR was significantly associated with an increased risk of postoperative infections, with a pooled odds ratio (OR) of 2.54 (95% CI: 1.84-3.52, p < 0.00001) and moderate heterogeneity (I² = 38.6%). Likewise, CRP and the CRP-to-albumin ratio (CAR) also demonstrated strong predictive value, with a pooled OR of 2.43 (95% CI: 1.45-4.09, p = 0.0007) and low heterogeneity (I² = 22.4%). These findings are in line with prior research that supports the role of systemic inflammatory markers in perioperative risk assessment. The use of NLR and CRP-based markers offers a simple, cost-effective, and accessible approach for early identification of patients at high risk for infectious complications. This can help clinicians initiate preventive strategies and optimize postoperative care. While further large-scale, prospective studies are needed to standardize cutoff values and timing of assessment, our results support incorporating NLR and CRP into routine perioperative evaluation in GI surgical settings.