A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio

Bailin Chen,Jian Cao,Jingyu Chen,Chengwei Yan,Chao Zheng,Chunbao Guo

doi:10.1186/s12887-021-03068-2

Abstract

BackgroundThe most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection.MethodsWe retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method.ResultsIn the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation.ConclusionThe preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.

Highlights

Childhood intussusception is a serious emergent disease that presents with the classic triad of abdominal pain, vomiting and red currant jelly stool [1, 2]
In terms of surgical planning and patient management, it is of great importance to detect potential complications early, as any delay may result in the impairment of intestinal circulation, which can cause intestinal necrosis, perforation or life-threatening secondary peritonitis, resulting in bowel resection and mortality [4]
We further investigated several combinations of inflammatory markers to identify the marker with the highest accuracy for predicting intestinal resection in patients with intussusception, including the NLR, PLR, LCR and CAR

Summary

Introduction

Childhood intussusception is a serious emergent disease that presents with the classic triad of abdominal pain, vomiting and red currant jelly stool [1, 2]. In terms of surgical planning and patient management, it is of great importance to detect potential complications early, as any delay may result in the impairment of intestinal circulation, which can cause intestinal necrosis, perforation or life-threatening secondary peritonitis, resulting in bowel resection and mortality [4]. Based on this understanding, potential biomarkers that can help identify patients with intestinal necrosis should be urgently developed. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection

Methods

Results

Discussion

Conclusion