A Surgeon's Predicament: Clinical Predictors of Surgery and Mortality in Neutropenic Enterocolitis
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In brief
In brief
Retrospective study of 74 pediatric cancer patients with neutropenic enterocolitis identifies Shock Index Pediatric Age-Adjusted (SIPA) as a predictor of mortality risk and need for surgical intervention. CT findings including bowel obstruction, pneumatosis, and extensive large bowel involvement were associated with progression to surgery.
Written by the GCMD Library team from the article.
Background
Neutropenic enterocolitis is uncommon but potentially life-threatening, with the cornerstone of treatment being medical management (MM), and surgical intervention reserved for clinical deterioration or bowel perforation. We hypothesized that the Shock Index Pediatric Age-Adjusted (SIPA) is elevated in patients who are at greatest risk for surgical intervention and mortality. We also sought to identify computed tomography (CT) findings associated with surgical intervention and mortality.
Methods
A single-center cancer registry was reviewed for neutropenic enterocolitis patients from 2006 -2018. Survival models compared patients with normal versus elevated SIPA throughout their hospitalizations for the time to surgical management (SM), as well as in-hospital mortality.
Results
Seventy-four patients with neutropenic enterocolitis were identified; 7 underwent surgery. In-hospital mortality was 12% in MM and 29% in SM; mortality among patients with elevated SIPA was 4.7 times higher compared to those with normal SIPA (95% CI: 1.1, 19.83, p=0.04). CT findings of bowel obstruction, pneumatosis, and a greater percentage of large bowel involvement were associated with surgical intervention (all ps