Neutrophil-to-Lymphocyte Ratio as a Predictor of the Need for Surgical Treatment in Children’s Intussusception

Carlos Delgado-Miguel; Antonella García; Bonifacio Delgado; Antonio Jesus Muñoz-Serrano; Miriam Miguel-Ferrero; Juan Camps; Manuel Lopez-Santamaria; Leopoldo Martinez

doi:10.1055/a-1913-4280

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2023; 33(05): 422-427
DOI: 10.1055/a-1913-4280

Original Article

Neutrophil-to-Lymphocyte Ratio as a Predictor of the Need for Surgical Treatment in Children’s Intussusception

Authors

Carlos Delgado-Miguel

¹Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
Antonella García

²Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Madrid, Madrid, Spain
Bonifacio Delgado

³Department of Mathematics, Complutense University of Madrid, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
Antonio Jesus Muñoz-Serrano

⁴Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
Miriam Miguel-Ferrero

⁴Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
Juan Camps

¹Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
Manuel Lopez-Santamaria

⁴Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain
Leopoldo Martinez

⁴Department of Pediatric Surgery, La Paz University Hospital Children Hospital, Ringgold Standard Institution, Madrid, Comunidad de Madrid, Spain

Abstract

Objective Neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory marker in abdominal pathologies. Ileocolic intussusception (ICI) involves a progressive intestinal inflammation, and the effectiveness of nonsurgical treatment (enema) might be related to the inflammation degree, although no previous studies have investigated this relationship. Our aim is to identify predictors of the need for surgical treatment in ICI.

Materials and Methods A single-center, retrospective, case-control study was performed in children with ICI, who were treated with initial nonsurgical management between 2005 and 2019. Patients were divided in two groups: A (effective enema) and B (need for surgery). Admission demographic and clinical and laboratory data were analyzed. Specificity and sensitivity of the different parameters as predictors of the need for surgical treatment were determined by receiver operating characteristic (ROC) curves.

Results A total of 511 patients were included (410: group A; 101: group B), without statistically significant demographic differences. Group B presented significantly higher frequency of vomiting, bloody stools, and longer median time since symptoms onset (24 vs. 8 hours; p < 0.001). Group B presented higher median laboratory inflammatory markers than group A: NLR (6.8 vs. 1.8; p < 0.001), neutrophils (10,148 vs. 7,468; p < 0.001), and C-reactive protein (CRP; 28.2 vs. 4.7; p < 0.001). In ROC curve analysis, NLR had an area under the curve of 0.925, higher than neutrophil count (0.776; p = 0.001), CRP (0.670; p = 0.001), and time since symptoms onset (0.673; p = 0.001). It was estimated a cut-off point of NLR greater than 4.52 (sensitivity: 73.2%; specificity: 94.5%).

Conclusion High NLR values imply a high degree of bowel inflammation and might anticipate the need for surgical treatment in ICI in children.

Level of Evidence III.

Keywords

neutrophil-to-lymphocyte ratio - ileocolic intussusception - surgical treatment - children

Full Text

References

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