The effect of oral protein and carbohydrate solution administration on NLR, IL-6 and CRP levels in patients undergoing surgery

Mahendratama P. Adhi; Oscar Febriano; Alfi Yasmina; Iwan Nuryawan; Agung Ary Wibowo; Kenanga Marwan Sikumbang

doi:10.62838/jccm-2026-0011

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The effect of oral protein and carbohydrate solution administration on NLR, IL-6 and CRP levels in patients undergoing surgery

The Journal of Critical Care Medicine

Volume 12 (2026): Issue 2 (April 2026)

By: Mahendratama P. Adhi, Oscar Febriano, Alfi Yasmina, Iwan Nuryawan, Agung Ary Wibowo and Kenanga Marwan Sikumbang

Open Access

|Apr 2026

Figures & Tables

PONV Incidence in the control group and the protein and carbohydrate combination solution group

PONV	Control Group	Intervention Group
No	40 (100%)	39 (100%)
Yes	0 (0%)	0 (0%)

The effect of protein and carbohydrate combination solution on NLR, IL-6, and CRP at level 2 surgical complexity

Variable	Group		p-value
Variable	Control (n=40)	Intervention (n=39)	p-value
NLR, mean±SD
Pre-Operation	3.12±2.03	2.61±1.89	0.241
24 hours post operation	8.74±4.09	6.92±3.91	0.060
Δ Post-Pre Operative	5.77±3.38	4.30±4.54	0.138

IL-6 (pg/ml), median (IQR)
Pre-Operation	4.37 (2.00–9.40)	2.64 (2.00–3.79)	0.036
24 hours post operation	19.00 (6.34–38.96)	7.00 (3.81–9.47)	0.004
Δ Post-Pre Operative	14.76 (1.98–26.52)	3.27 (1.54–5.22)	0.035

CRP (mg/dL), median (IQR)
Pre-Operation	2.50 (1.00–7.50)	3.25 (0.90–5.02)	0.568
24 hours post operation	24.40 (9.90–45.80)	9.55 (3.65–14.52)	0.015
Δ Post-Pre Operative	16.90 (5.20–42.10)	4.45 (–0.07–10.65)	0.024

The effect of administering a combined protein and carbohydrate solution on NLR, IL-6 and CRP at level 3 surgical complexity

Variable	Group		p-value
Variable	Control (n=40)	Intervention (n=39)	p-value
NLR, mean±SD
Pre-Operation	3.50±2.50	4.01±3.12	0.367
24 hours post operation	8.46±4.06	8.86±5.24	0.893
Δ Post-Pre Operative	4.96±4.38	4.85±4.77	0.954

IL-6 (pg/ml), median (IQR)
Pre-Operation	3.79 (2.15–12.28)	3.62 (2.00–7.67)	0.603
24 hours post operation	27.02 (18.51–93.43)	22.56 (10.48–40.85)	0.199
Δ Post-Pre Operative	17.37 (12.17–83.70)	15.65 (5.81–27.86)	0.478

CRP (mg/dL), median (IQR)
Pre-Operation	3.80 (1.75–33.95)	12.50 (1.30–33.60)	0.803
24 hours post operation	66.40 (34.90–84.90)	36.90 (24.40–68.50)	0.140
Δ Post-Pre Operative	41.00 (19.45–70.00)	25.80 (7.30–55.50)	0.103

Factors affecting changes in NLR, IL-6 and CRP in surgery patients

Variable	NLR			IL6			CRP

	p-value	Regression coefficient	95% (Lower-Upper)	p-value	K Regression coefficient	95% (Lower-Upper)	p-value	Regression coefficient	95% (Lower-Upper)
Age	0.315	–0.41	–0.122–0.040	0.102	–0.710	–1.564–0.144	0.785	–0.099	–0.816–0.619
Administration of a combination of protein and carbohydrate solutions	0.233	–1.146	–3.045–0.752	0.072	–18.285	–38.273–1.704	0.028	–18.919	–35.709 – (–2.129)
Gender	0.859	0.187	–1.914–2.288	0.199	–14.370	–36.490–7.750	0.496	–6.376	–24.955 – 12.204
ASA	0.985	0.056	–5.989–6.101	0.797	8.231	–55.415–71.878	0.002	–86.232	–139.692 – (–32.772)
Operation Level	0.496	–0.718	–2.810–1.374	0.052	21.826	–0.201–43.853	0.045	18.906	0.404 – 37.407
Operatime Time	0.037	0.016	0.001–0.031	0.803	–0.020	–0.78–0.138	0.563	0.039	–0.094–0.72
BMI	0.166	–0.190	–0.461–0.081	0.344	–1.363	–4.213–1.488	0.356	–1.116	–3.511–1.278

The effect of administering a combined protein and carbohydrate solution on NLR, IL-6 and CRP

Variable	Group		p-value
Variable	Control (n=40)	Intervention (n=39)	p-value
NLR, mean±SD
Pre-Operation	3.24±2.17	3.29±2.63	0.818
24 hours post operation	8.65±4.33	7.86±4.65	0.308
Δ Post-Pre Operative	5.51±3.70	4.57±4.60	0.220

IL-6 (pg/ml), median (IQR)
Pre-Operation	4.08 (2.00–9.77)	2.88 (2.00–5.74)	0.110
24 hours post operation	20.08 (11.64–50.11)	9.49 (6.03–22.65)	0.011
Δ Post-Pre Operative	16.40 (3.00–38.02)	5.30 (2.56–17.33)	0.096

CRP (mg/dL), median (IQR)
Pre-Operation	2.65 (1.12–13.12)	2.90 (1.30–7.20)	0.803
24 hours post operation	34.70 (11.87–71.55)	15.10 (7.20–41.60)	0.056
Δ Post-Pre Operative	26.40 (7.20–41.60)	9.90 (2.30–30.60)	0.062

Patient characteristics

Variable	Group		p-value
Variable	Control (n=40)	Intervention (n=39)	p-value
Age (years), mean±SD	40.22±12.06	40.38±11.47	0.953*

Gender
Men	15 (37.5%)	10 (25.6%)	0.257**
Women	25 (62.5%)	29 (74.4%)
BMI (kg/m²), mean±SD	23.67±3.24	23.50±3.80	0.839***

Operation level
Level 2	27 (67.5%)	20 (51.3%)	0.142**
Level 3	13 (32.5%)	19 (48.7%)
Operation time (minutes)	144.25±61.75	161.41±72.99	0.383*

ASA Status
ASA I	1 (2.5%)	1 (2.6%)	1.000****
ASA II	39 (97.5%)	38 (97.4%)

References

Authors

Metrics

Articles in this issue

DOI: https://doi.org/10.62838/jccm-2026-0011 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 243 - 251

Submitted on: Aug 22, 2025

Accepted on: Feb 2, 2026

Published on: Apr 30, 2026

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

protein and carbohydrate solution,

neutrophil-lymphocyte ratio,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2026 Mahendratama P. Adhi, Oscar Febriano, Alfi Yasmina, Iwan Nuryawan, Agung Ary Wibowo, Kenanga Marwan Sikumbang, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 12 (2026): Issue 2 (April 2026)