Association Between Perioperative Inflammatory Trajectories and Postoperative Hirschsprung-Associated Enterocolitis:...

Area of Science:

• Pediatric Surgery
• Inflammation Biomarkers
• Gastroenterology

Background:

• Hirschsprung disease (HSCR) is a congenital condition requiring surgical intervention.
• Postoperative Hirschsprung-associated enterocolitis (HAEC) is a serious complication following HSCR surgery.
• Understanding perioperative inflammatory responses is crucial for predicting HAEC risk.

Purpose of the Study:

• To analyze dynamic changes in perioperative inflammatory markers in pediatric HSCR patients.
• To identify distinct inflammatory marker trajectory patterns using Group-Based Trajectory Modeling (GBTM).
• To investigate the association between these trajectory patterns and the risk of developing postoperative HAEC.

Main Methods:

• Retrospective cohort study of 400 pediatric patients with HSCR undergoing one-stage laparoscopic surgery.
• Collection of blood samples at four perioperative time points (preoperative, postoperative days 1, 4, 7).
• Calculation of inflammatory markers including Systemic Inflammation Response Index (SIRI), Pan-Immune-Inflammation Value (PIV), white blood cell (WBC), and neutrophil counts.
• Application of GBTM to define inflammatory marker trajectories and multivariable logistic regression to assess HAEC risk.

Main Results:

• 133 out of 400 patients (33.3%) developed postoperative HAEC.
• Distinct trajectory groups were identified for SIRI, PIV, WBC, and neutrophils.
• Elevated SIRI and PIV trajectories (moderate to high baseline with sharp rise) significantly increased HAEC risk (ORs ranging from 4.75 to 5.63).
• Persistently high WBC or a sharp rise and rapid decline in neutrophils were also independent risk factors for HAEC (ORs around 2.5).

Conclusions:

• Specific perioperative inflammatory marker trajectories, particularly rising patterns of SIRI, PIV, WBC, and neutrophils, are associated with increased HAEC risk.
• These dynamic inflammatory changes may serve as novel biomarkers for early HAEC risk stratification in pediatric HSCR patients.
• Identifying high-risk patients through these biomarkers can potentially guide timely interventions and improve outcomes.