The platelet count combined with activated partial thromboplastin time as predictive marker for predicting surgical necrotizing enterocolitis

The platelet count to activated partial thromboplastin time ratio (PAR) is a validated laboratory marker that reflects the severity of systemic inflammatory responses and coagulation dysfunction. However, the predictive value of PAR for surgical necrotizing enterocolitis (NEC) remains poorly defined. The study aimed to investigate clinical value of PAR in predicting surgical NEC.

The retrospective study was conducted on 112 very low birth weight (VLBW) infants diagnosed with NEC during the hospitalization at The First Affiliated Hospital of Anhui Medical University from March 2016 to February 2026. Clinical baseline data, laboratory parameters, treatment strategies and prognostic outcomes of all enrolled infants were systematically collected and treated. The included population was stratified into surgical and non-surgical groups according to surgical intervention or conservative treatment. Univariate logistic regression analyses were used to identify risk factors for NEC surgical intervention. Receiver operating characteristic (ROC) curve was applied to assess the predictive markers for surgical NEC.

Among the 112 enrolled NEC infants, 21 cases (18.75%) ultimately received surgical treatment. Baseline laboratory tests at NEC diagnosis revealed significant differences in predictive indicators. The surgical group exhibited significantly lower platelet count (PLT) and lymphocyte count (LY), as well as markedly prolonged activated partial thromboplastin time (APTT) compared with the non-surgical group. Multivariate regression analysis confirmed that PAR [odds ratio (OR) =0.561, 95% confidence interval (CI): 0.395-0.798, P=0.001] and platelet-to-lymphocyte ratio (PLR) (OR =1.008, 95% CI: 1.003-1.014, P=0.002) were independent risk factors for surgical NEC. ROC analysis showed that PAR possessed predictive efficacy for high-risk factor of surgical NEC, with a sensitivity of 75.7% and specificity of 74.3%, and the area under the curve (AUC) was 0.729. PLR predictor demonstrated a sensitivity of 71.4% and specificity of 73.2%, and the AUC was 0.722. A decreased PAR value and increased PLR levels at the onset of NEC were significantly associated with adverse clinical outcomes.

PAR and PLR are reliable, simple, and accessible prognostic biomarkers for early prediction of surgical intervention in NEC which have the potential to become reference indicators for clinical decision-making.