Department of Pediatric Surgery, The Royal London Hospital, London, UK.
Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Pediatr Surg Int. 2021 Jul;37(7):881-886. doi: 10.1007/s00383-021-04879-1. Epub 2021 Mar 29.
The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC).
Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI).
A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63-0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54-0.77); p = 0.0150], respectively.
A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.
低白蛋白血症和 C 反应蛋白（CRP）水平升高在预测成人重症预后方面的作用已在大量文献中得到描述。然而，儿科，特别是新生儿的研究有限。CRP/白蛋白（CRP/ALB）比值通常与更高的死亡率、器官衰竭和住院时间延长相关。我们假设 CRP/ALB 比值在预测患有坏死性小肠结肠炎（NEC）的新生儿的手术和死亡率方面具有预后价值。
回顾性分析 2009 年至 2018 年期间在一家三级转诊医院接受治疗的所有具有非穿孔性 NEC 临床和放射学证据的新生儿。记录一般患者人口统计学、实验室参数和结局。进行受试者工作特征分析，以评估最佳截断值和曲线下面积（AUC）及其 95%置信区间（CI）。
共确定了 191 名新生儿。其中，103 名（53.9%）出生于≤28 周妊娠，101 名（52.9%）出生体重≤1000g。84 名（44.0%）患者因 NEC 接受手术干预。总体存活率为 161/191（84.3%）。NEC 诊断第 2 天 CRP/ALB 比值≥3 与手术[AUC 0.71（95% CI 0.63-0.79）；p<0.0001]和死亡率[AUC 0.66（95% CI 0.54-0.77）；p=0.0150]的可能性显著增加相关。
NEC 确诊的非穿孔性新生儿第 2 天 CRP/ALB 比值≥3 提示存在关键途径。这可作为指导 NEC 手术干预和死亡率的父母咨询的附加标准。
