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Association Between Perioperative Inflammatory Trajectories and Postoperative Hirschsprung-Associated Enterocolitis:
Zhengxing Jiang1, Wei Feng1, Hongtao Hu1
1Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, People's Republic of China.
Insights
Rising inflammatory markers like SIRI and PIV after surgery for Hirschsprung disease (HSCR) indicate a higher risk of Hirschsprung-associated enterocolitis (HAEC). These inflammatory trajectories can help identify at-risk children early.
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.
Purpose:
This retrospective cohort study aimed to delineate the dynamic change trajectories of perioperative inflammatory markers in pediatric patients with Hirschsprung disease (HSCR) who underwent one-stage laparoscopic-assisted pull-through surgery at a single tertiary pediatric center using Group-Based Trajectory Modeling (GBTM), and to explore the association between different trajectory patterns and the risk of postoperative Hirschsprung-associated enterocolitis (HAEC).
Methods:
This study enrolled HSCR patients who underwent surgical treatment. Blood samples were collected at four perioperative time points (preoperative, postoperative days 1, 4, and 7) to calculate composite inflammatory markers such as the systemic inflammation response index (SIRI) and pan-immune inflammation value (PIV), as well as individual markers like white blood cell (WBC) and neutrophil counts. GBTM was employed to identify subgroups with similar inflammatory marker change trajectories. Multivariable logistic regression analysis was used to assess the association between different inflammatory trajectories and postoperative HAEC occurring within several years after surgery.
Results:
A total of 400 patients were included, of which 133 (33.3%) developed postoperative HAEC. Each inflammatory marker was categorized into 2-3 significantly distinct trajectory groups via GBTM. Multivariable logistic regression analysis revealed that for SIRI and PIV, compared to trajectory group 1 (low baseline with mild rise), patients in trajectory group 2 (moderate baseline with sharp rise and slow decline; SIRI: OR = 5.20, P = 0.011; PIV: OR = 4.75, P = 0.007) and trajectory group 3 (high baseline with sharp rise and slow decline; SIRI: OR = 4.73, P = 0.025; PIV: OR = 5.63, P = 0.008) had a significantly increased risk of postoperative HAEC. For WBC and neutrophils, trajectory group 2 (WBC: persistently high; neutrophils: low baseline with sharp rise and rapid decline) was an independent risk factor for postoperative HAEC (WBC: OR = 2.49, P = 0.004; neutrophils: OR = 2.53, P = 0.001).
Conclusion:
Specific rising trajectories of SIRI, PIV, WBC, and neutrophils may serve as novel biomarkers for early identification of children at high risk for HAEC.
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