Correlation between pathology indicators and intestinal necrosis in pediatric intussusception

BACKGROUND: Operative management in pediatric intussusception involves immediate manual reduction. Intestinal resection due to ischemia and necrosis becomes a concern. Therefore, early prediction of intestinal ischemia and necrosis with laboratory inflammatory markers and their ratios may help surgeons determine further management. The markers used in this study are generally performed and cost-effective. This study aimed to determine whether inflammatory markers and their ratios were associated with the incidence of intestinal necrosis in pediatric intussusception.METHODS: This observational analytic study used a cross-sectional design to determine the potential of lymphocyte and neutrophil levels, platelet level, albumin level, platelet-lymphocyte ratio, C-reactive protein (CRP)-albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), and lymphocyte-CRP ratio (LCR) as determinants of intestinal necrosis conditions in pediatric intussusception disease. The data were tested using the Chi-square Test and logistic regression to determine the predictive value of these measures. Receiver operating characteristic analysis was used to determine cutoff values.RESULTS: Of 36 patients, 38.9% had intestinal necrosis found during laparotomy. Significantly related markers were albumin (P=0.00; area under the curve AUC 88.8%), CRP (P=0.00; AUC 94.8%), CAR (P=0.00; AUC 91.4%), NLR (P=0.032; AUC 71.4%), and LCR (P<0.001; AUC 90.6%). CRP and albumin were the most significant.CONCLUSIONS: Inflammatory markers significantly related to intestinal necrosis were albumin, CRP, CAR, NLR, and CRP-lymphocyte, with albumin and CRP being the most significant. These markers may help determine suspected intestinal necrosis before choosing non-operative reduction or operative management.