Bypassing the Delay: Directing Pediatric Intussusception Cases to the OR Through Inflammatory Marker Assessment

Intestinal necrosis represents as one of the most severe complications of intussusception. Various markers of systemic inflammation, such as neutrophil counts, CRP levels, albumin concentrations, platelet counts, and lymphocyte counts as well as combined ratios, such as lymphocyte-to-CRP ratio (LCR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and CRP-to-albumin ratio (CAR), have been proposed as valuable predictors for a variety of inflammatory conditions, making them useful biomarkers for inflammation. We investigated the effectiveness of different combinations of inflammatory markers in predicting intestinal necrosis and the need for intestinal resection in cases of intussusception.

This is a retrospective cohort study that included 100 patients diagnosed with intussusception and needed surgical intervention after failed nonoperative reduction of intussusception. The patients were divided into two groups based on whether they had intestinal resection. Analysis was conducted on combinations of inflammatory markers, such as NLR, PLR, LCR, and CAR, to correlate with intraoperative findings for detecting the markers with the highest correlation with intestinal necrosis in intussusception patients.

A statistically significant higher mean CAR was observed among cases with resection (15.27 ± 6.74) compared to the nonresection group (3.56 ± 4.06). Conversely, the mean LCR was significantly lower in the resection group (0.116 ± 0.12) compared to the nonresection group (0.509 ± 0.33). The ROC analysis showed that the area under the curve (AUC) for LCR in differentiating cases requiring resection was excellent, with a best-detected cutoff point of 0.1233, yielding a sensitivity of 85.7% and specificity of 90%. Similarly, the AUC for CAR in differentiating cases needing intestinal resection was excellent, with a best-detected cutoff point of 7.73, yielding a sensitivity of 92.6% and specificity of 90%. Additionally, the CAR was a statistically significant predictor of the need for resection, with each unit increase in CAR increasing the risk by 1.42 (95% CI: 1.25-1.61).

The mean CRP-to-albumin ratio (CAR) is significantly higher in cases requiring intestinal resection compared to those that do not require resection. LCR also provides useful information and should be used alongside the CAR in the decision-making process. If a patient's CAR exceeds 7.73 and if LCR is below 0.1233, they are more likely to need surgery due to necrosis. Given its statistical significance, CAR should be used as a key marker for predicting the need for intestinal resection. For each one-unit increase in CAR, the risk of needing intestinal resection increases by 1.42 times, which can aid in prioritizing patients for surgery, avoiding treatment delays, and enhancing patient outcome.