Assessment of inflammatory biomarkers to identify surgical/death necrotizing enterocolitis in preterm infants without pneumoperitoneum
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In brief
In brief
Study of 90 preterm infants with necrotizing enterocolitis demonstrates that combining four inflammatory markers (ANC, PLR, CRP, PCT) can predict which patients require surgery or are at risk of death, with 88% specificity. Elevated platelet-to-lymphocyte ratio emerges as a key indicator of severe inflammation in surgical NEC cases.
- Elevated platelet-to-lymphocyte ratio (PLR) is associated with severe inflammation in surgical/death NEC without pneumoperitoneum.
- Combined biomarkers (ANC, PLR, CRP, PCT) predict surgical/death NEC with 88% specificity and 63% sensitivity (AUC 0.79).
- WBC, ANC, PLR, CRP, and PCT measured within 24h of onset are significantly higher in surgical/death NEC versus medical NEC.
- A predictive model using four inflammatory markers may help identify preterm infants requiring surgical intervention earlier.
- This biomarker panel could improve nurse-clinician communication and risk stratification in NEC management.
Written by the GCMD Library team from the article.
Abstract
Background
Necrotizing enterocolitis (NEC) is a life-threatening disease that affects premature infants. However, the role of inflammatory biomarkers in identifying surgical/death NEC without pneumoperitoneum remains elusive.
Purpose
We aimed to verify the value of platelet-to-lymphocyte ratio (PLR) and the combination of white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil lymphocyte ratio (NLR), PLR, C reactive protein (CRP) and procalcitonin (PCT) in predicting the severity of NEC, and to construct a model to differ surgically NEC from non-surgically NEC.
Methods
A retrospective analysis was performed on 191 premature infants with NEC. Based on the inclusion and exclusion criteria, 90 infants with Stage II and IIIA NEC were enrolled in this study, including surgical/death NEC (n = 38) and medical NEC (n = 52). The values of inflammatory biomarkers were collected within 24 h of onset.
Results
The univariate analysis revealed that the values of WBC (p = 0.040), ANC (p = 0.048), PLR (p = 0.009), CRP (p = 0.016) and PCT (p < 0.01) in surgical/death NEC cohort were significantly higher than medical NEC cohort. Binary multivariate logistic regression analysis indicates that ANC, PLR, CRP, and PCT are capable of distinguishing infants with surgical/death NEC, and the AUC of the regression equation was 0.79 (95% CI 0.64–0.89; sensitivity 0.63; specificity 0.88), suggesting the equation has a good discrimination.
Implications for practice and research
Elevated PLR is associated with severe inflammation in surgical/death NEC patients. The prediction modelling of combination of ANC, PLR, CRP and PCT can differentiate surgical/death NEC from infants with medical NEC, which may improve risk awareness and facilitate effective communication between nurses and clinicians. However, multicentre research is needed to verify these findings for better clinical management of NEC.