Application of coagulation parameters at the time of necrotizing enterocolitis diagnosis in surgical intervention and prognosis

Abstract

Purpose It has been shown that abnormalities of coagulation and fibrinolysis system are involved in the pathogenesis of necrotizing enterocolitis (NEC), but not well studied challenge in the context of early detection of disease progression. The present study mainly explores the predictive significance of coagulation parameters at the time of NEC diagnosis in identifying the patients who eventually received surgery and/or NEC-related deaths. Methods The retrospective study of 114 neonates with NEC was conducted with assessments of demographic data, laboratory results at the time of NEC diagnosis, treatment methods and prognosis. According to treatment methods, patients were divided into surgical intervention group and medical treatment group. Predictive factors were put forward and determined by receiver operating characteristic (ROC) curve analysis. An analysis of the surgical intervention and prognosis was performed. Results Of 114 patients, 46 (40.4%) cases received surgical intervention and 14 (12.3%) deaths. prothrombin time (PT), PT international normalized ratio, activated partial thromboplastin time (APTT), fibrinogen and platelet count at the time of NEC diagnosis were independently associated with surgical NEC. The APTT could identify patients at high risk for surgical NEC, with 67.39% sensitivity, 86.76% specificity, better than that of other serological parameters. Coagulopathy was found in 38.6% of all patients. For surgical intervention, the area under the ROC curve (AUC) of coagulopathy was 0.869 (95% confidence interval [CI]: 0.794 ~ 0.944, P < 0.001), with 82.61% sensitivity and 91.18% specificity, outperformed APTT (95% CI: 0.236 ~ 0.173, P = 0.001). Furthermore, the AUC for coagulopathy to predict mortality was 0.809 (95% CI: 0.725 ~ 0.877, P < 0.001), with 92.86% sensitivity and 69.0% specificity. Conclusion Coagulation parameters at the time of NEC diagnosis were conducive to early prediction of surgical NEC and -related deaths, which should be closely monitored in neonates at high risk of NEC and validated as a clinical decision-making tool.

Correlation of systemic immune-inflammation Index with surgical necrotizing enterocolitis

“…Recently, there are various methods used to predict surgical NEC, among which inflammatory markers were more common because inflammatory mediators play a critical role in the occurrence of NEC. Early predictors that have been reported are as follows: C-reactive protein/albumin ratio, serum albumin concentration, interleukin (IL) 6 and coagulation function at NEC diagnosis, trends in C-reactive protein and lactate within 72 h of NEC diagnosis, IL-8 and IL-10 within 72 h of life (infants born less than 1500 g), and hyponatremia and/or the sudden decrease in plasma sodium at the onset of NEC (2,16,(31)(32)(33)(34). However, these methods have at least one of the following deficiencies, which limit clinical use and promotion: lack of enough sensitivity and specificity, expensive, inconvenience.…”

“…The clinical data of patients with NEC (Bell's stage ≥ II) admitted to our department during the study period were analyzed retrospectively. The inclusion criteria were: (1) patients were diagnosed with NEC according to the radiological evidence (i.e., pneumatosis intestinalis) and presence of one or more clinical fndings (i.e., abdominal distension, bilious/bloody aspirates, blood per rectum, abdominal tenderness, abdominal wall erythema/discoloration or abdominal mass) ( 16 ), and (2) those who had complete medical records and postoperative follow-up data. The exclusion criteria were as follows: (1) patients with digestive system deformity that increase the risk of secondary NEC, like Hirschsprung's disease, (2) those received surgery for intestinal perforation due to meconium-related ileus, (3) those with hematologic diseases, (4) those identified as “spontaneous isolated intestinal perforation” by the operating surgeon and histologically, (5) those with incomplete clinical data.…”

“…Surgical intervention was defined as performance of exploratory laparotomy or placement of a peritoneal drain. Indications for surgery included evidence of intestinal perforation (free intraperitoneal air on radiological examination) and/or clinical deterioration (increasing abdominal distension, erythema, discoloration and tenderness) despite maximum conservative treatment ( 16 ). It is worth noting that the relative surgical indications of NEC are still controversial, such choices were dictated by the clinical judgment of the pediatric surgeon in coordination with neonatologist.…”

“…According to our clinical practice, some patients did not receive surgical intervention during the acute process of NEC, but needed surgery due to later complications, which actually had a causal relationship ( 17 , 18 ). So, to improve the clinical practicability, this study also included the patients who received medical treatment for NEC but had surgery for later complications of NEC including persistent intestinal obstruction or stricture during 3-month follow-up period ( 16 ).…”

“…This is a teaching and research hospital where medical students and residents collect the clinical data of patients using standardized forms under the supervision of senior pediatricians and professors. treatment (16). It is worth noting that the relative surgical indications of NEC are still controversial, such choices were dictated by the clinical judgment of the pediatric surgeon in coordination with neonatologist.…”