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

Abstract

Background The 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. Methods We 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. Results In 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. Conclusion The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.

Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction

“…Although limited studies have revealed the relationship between WBCs count and failure of hydrostatic intussusception reduction, the association between WBCs count and intestinal necrosis has been revealed previously. In Chen's study, they found that patients underwent intestinal resection due to intestinal necrosis had significantly higher WBCs count than those without any resection ( 18 ). In 2020, Chen et al ( 19 ) developed a prediction model that used WBCs count as an important risk factor.…”

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

“…As shown in our nomogram, CRP significantly contributed to intestinal necrosis, with higher CRP level greatly increasing the risk of intestinal necrosis and indicating the severity of the illness. Some predictive models also took CRP into consideration ( 25 , 26 ) consistent with the current study. Total leukocyte count has traditionally been considered a hallmark of infection and inflammation ( 27 ).…”

“…Coherent with the observations we made, Chen et al ( 24 ) concluded WBCs increased more in severe intestinal obstruction than less severe cases. A study conducted on childhood intussusception after surgery also came to the same conclusion that CRP and WBCs levels were higher in patients who underwent bowel resection than those who underwent manual surgical reduction merely ( 25 ). Wu et al ( 11 ) study showed that WBCs level was higher in bowel resection than non-bowel resection, although the difference was not statistically significant due to small sample size.…”

Prostaglandin E-major urinary metabolites as a new biomarker for acute mesenteric ischemia

“…Laboratory test values such as lactate, liver enzymes, C-reactive protein, and lymphocytes, among others, have been investigated to identify markers of intestinal ischemia/necrosis. [3][4][5][6]29,30 Although markers of intestinal ischemia such as i-FABP, D-lactate, and SM22 have been recently reported, 2,8-11 their clinical application has not gained widespread acceptance. Because of its simplicity, PGE-MUM measurements can be easily applied to the assessment of intestinal ischemia as it is already being used clinically in patients with UC.…”

“…Laboratory test values such as lactate, liver enzymes, C-reactive protein, and lymphocytes, among others, have been investigated to identify markers of intestinal ischemia/necrosis 3–6,29,30 . Although markers of intestinal ischemia such as i-FABP, d -lactate, and SM22 have been recently reported, 2,8–11 their clinical application has not gained widespread acceptance.…”