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Haemostatic indexes for predicting intestinal necrosis in children with intussusception
Hui-Ya Huang1, Xiao-Kun Lin2, Shi-Kun Guo2
1Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Insights
Longer symptom duration, high fibrinogen, and elevated d-dimer levels are key risk factors for intestinal necrosis in children with intussusception after failed non-surgical reduction. D-dimer levels offer the best predictive value for this complication.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hematology
Background:
- Intussusception is a common surgical emergency in children.
- Failed non-surgical reduction of intussusception increases the risk of complications, including intestinal necrosis.
- Identifying predictors of intestinal necrosis is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for intestinal necrosis in pediatric intussusception cases with failed non-surgical reduction.
- To evaluate the predictive value of hematological parameters for intestinal necrosis.
Main Methods:
- Retrospective study of 540 children with intussusception and failed air-enema reduction.
- Comparison of demographic, clinical, and hemostatic parameters between groups with and without intestinal necrosis.
- Univariable and multivariable logistic regression analyses to identify predictors of intestinal necrosis.
Main Results:
- 113 out of 540 patients (20.9%) developed intestinal necrosis.
- Intestinal necrosis was associated with longer symptom duration, younger age, and higher platelet counts, fibrinogen, and d-dimer levels.
- Multivariable analysis identified symptom duration, fibrinogen, and d-dimer as independent predictors of intestinal necrosis. D-dimer demonstrated the highest predictive accuracy.
Conclusions:
- Long symptom duration, elevated fibrinogen, and high d-dimer levels on admission are significant risk factors for intestinal necrosis in pediatric intussusception with failed non-surgical reduction.
- D-dimer levels are the most effective biomarker for predicting intestinal necrosis in this patient population.
Background:
To determine risk factors for intestinal necrosis in intussusception cases among children with failed non-surgical reduction for intussusception.
Methods:
Totally, 540 hospitalized individuals with unsuccessful air-enema reduction in our hospital between November 2010 and November 2020 were assessed in this retrospective study. The 540 intussusception cases were divided into the intestinal necrosis and non-intestinal necrosis groups. Haemostatic parameters, demographic and clinical features were assessed. Predictors of intestinal necrosis were examined by univariable and multivariable logistic regression analyses.
Results:
Of the 540 patients included, 113 showed intestinal necrosis. This intestinal necrosis group had a longer duration of symptom or length of illness, younger ages, higher platelet counts, fibrinogen amounts and d-dimer levels (all P = 0.000) compared with the non-intestinal necrosis group. Multivariable analysis revealed that duration of symptom (odds ratio (OR) 1.12; 95% confidence interval (CI) 1.16-1.23, P = 0.000), fibrinogen (OR 1.26; 95% CI 1.10-1.31, P = 0.010) and d-dimer (OR 2.07; 95% CI 1.91-2.28, P = 0.000) independently predicted intestinal necrosis in individuals undergoing surgical reduction for intussusception. Receiver operating characteristic curve analysis showed that d-dimer amounts had the largest area under the curve for predicting intestinal necrosis.
Conclusion:
On admission, long duration of symptom, high fibrinogen and d-dimer levels are critical risk factors for intestinal necrosis development in children with unsuccessful non-surgical reduction. d-Dimer levels have the best predictive value for intestinal necrosis.
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