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Preoperative immunonutritional and inflammatory indices as predictors of secondary post-tonsillectomy hemorrhage in
Oğuz Kadir Eğilmez1, Halil Elden1, Aykan Kandemir1
1Sakarya University Training and Research Hospital, Department of Otorhinolaryngology, Sakarya, Turkey.
Insights
Secondary post-tonsillectomy hemorrhage (PTH) in children is linked to inflammation and nutrition. Prognostic nutritional index (PNI) and hemoglobin-albumin-lymphocyte-platelet (HALP) score can help predict and assess bleeding risk.
Area of Science:
- Pediatric Surgery
- Immunonutrition
- Inflammatory Markers
Background:
- Secondary post-tonsillectomy hemorrhage (PTH) is a significant complication in pediatric patients.
- Predictive markers for secondary PTH are currently limited.
- Understanding the interplay of inflammatory and nutritional status is crucial for risk assessment.
Purpose of the Study:
- To investigate the association between preoperative inflammatory and immunonutritional indices and secondary PTH in pediatric patients.
- To evaluate the prognostic value of the prognostic nutritional index (PNI) and hemoglobin-albumin-lymphocyte-platelet (HALP) score for secondary PTH.
- To analyze dynamic changes in these indices during hemorrhage events.
Main Methods:
- Retrospective cohort study of 2250 pediatric patients undergoing tonsillectomy or adenotonsillectomy.
- Comparison of preoperative inflammatory and immunonutritional indices (PNI, HALP, SII, NLR, PLR) between patients with and without secondary PTH.
- Analysis of dynamic changes in PNI and HALP from surgery day (T0) to bleeding day (T1) in the PTH group.
- Receiver operating characteristic (ROC) analysis to determine predictive performance.
Main Results:
- Patients with secondary PTH had significantly lower preoperative PNI and HALP, and higher SII, NLR, and PLR (p < 0.001).
- In the PTH group, PNI and HALP decreased, while inflammatory indices increased significantly from T0 to T1 (p < 0.001).
- PNI (AUC=0.704) and HALP (AUC=0.666) demonstrated meaningful predictive capability for secondary PTH.
Conclusions:
- Both preoperative and dynamic peri-hemorrhagic changes in immunonutritional indices are strongly associated with secondary PTH.
- PNI and HALP show potential as practical tools for risk stratification in pediatric tonsillectomy patients.
- A multidimensional inflammatory-nutritional assessment may improve prediction of secondary PTH.
Objective:
Secondary post-tonsillectomy hemorrhage (PTH) remains a clinically significant complication in pediatric patients, and reliable preoperative predictors are limited. This study aimed to investigate the association between inflammatory and immunonutritional indices and secondary PTH, with particular emphasis on prognostic nutritional index (PNI) and hemoglobin-albumin-lymphocyte-platelet (HALP) score.
Methods:
This retrospective cohort study included 2250 pediatric patients who underwent tonsillectomy or adenotonsillectomy. Ninety patients who developed secondary PTH were compared with 2160 patients without hemorrhage. Preoperative inflammatory and immunonutritional indices, including PNI, HALP, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were analyzed. In patients with secondary PTH, dynamic changes between the day of surgery (T0) and the day of bleeding (T1) were evaluated. Receiver operating characteristic (ROC) analyses were performed to assess predictive performance.
Results:
Patients with secondary PTH demonstrated significantly lower preoperative PNI and HALP values, along with higher SII, NLR, and PLR levels compared with patients without hemorrhage (all p < 0.001). In the PTH group, PNI and HALP declined significantly on the bleeding day, whereas inflammatory indices increased (p < 0.001). ROC analysis showed that PNI (AUC = 0.704) and HALP (AUC = 0.666) provided meaningful discrimination for secondary PTH, comparable to traditional inflammatory markers.
Conclusion:
Both preoperative and dynamic peri-hemorrhagic changes in immunonutritional indices are closely associated with secondary post-tonsillectomy hemorrhage. PNI and HALP may serve as practical adjunctive tools for risk stratification, supporting a multidimensional inflammatory-nutritional assessment in pediatric tonsillectomy patients.
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