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

Variable	Group		p-value
Control (n=40)	Intervention (n=39)
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%)

Notes: BMI: Body Mass Index, ASA: American Society of Anesthesiologists, SD: Standard Deviation;

* Mann-Whitney,

** Chi-square,

*** Independent T-Test,

**** Fisher Exact

Table 2.

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

Control (n=40)	Intervention (n=39)
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

[i] Notes: IL-6: Interleukin-6, CRP: C-Reactive Protein, NLR: Neutrophil-Lymphocyte Ratio, SD: Standard Deviation, Δ: delta (mean change pre-operatively to post-operatively)

Table 3.

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

Variable	Group		p-value
Control (n=40)	Intervention (n=39)
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

[i] Notes: IL-6: Interleukin-6, CRP: C-Reactive Protein, NLR: Neutrophil-Lymphocyte Ratio, SD: Standard Deviation, Δ: delta (mean change pre-operatively to post-operatively

Table 4.

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

Control (n=40)	Intervention (n=39)
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

[i] Notes: IL-6: Interleukin-6, CRP: C-Reactive Protein, NLR: Neutrophil-Lymphocyte Ratio, SD: Standard Deviation, Δ: delta (mean change pre-operatively to post-operatively)

Table 5.

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

Variable	NLR			IL6			CRP
Variable	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

[i] Notes: NLR: Neutrophil-Lymphocyte Ratio, IL-6: Interleukin-6, CRP: C-Reactive Protein, ASA: American Society of Anesthesiologists, BMI: Body Mass Index

Table 6.

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%)

References

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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)