Abstract
Abstract
Purpose
The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC).
Methods
Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI).
Results
A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63–0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54–0.77); p = 0.0150], respectively.
Conclusions
A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.
Funder
Johann Wolfgang Goethe-Universität, Frankfurt am Main
Publisher
Springer Science and Business Media LLC
Subject
General Medicine,Surgery,Pediatrics, Perinatology and Child Health
Reference24 articles.
1. Lang J, Hickey L, King S, Curley A (2019) OC58 morbidity and mortality of medical and surgical necrotising enterocolitis. Arch Dis Child 104:A24
2. Jones IH, Hall NJ (2020) Contemporary outcomes for infants with necrotizing enterocolitis—a systematic review. J Pediatr 220:86-92.e3
3. Robinson JR, Rellinger EJ, Hatch LD et al (2017) Surgical necrotizing enterocolitis. Semin Perinatol 41:70–79
4. Munaco AJ, Veenstra MA, Brownie E, Danielson LA, Nagappala KB, Klein MD (2015) Timing of optimal surgical intervention for neonates with necrotizing enterocolitis. Am Surg 81:438–443
5. Bonasso PC, Dassinger MS, Ryan ML, Gowen MS, Burford JM, Smith SD (2019) 24-hour and 30-day perioperative mortality in pediatric surgery. J Pediatr Surg 54:628–630
Cited by
15 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献