Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States; Department of Surgery, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, United States.
The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, United States.
J Pediatr Surg. 2022 Mar;57(3):443-449. doi: 10.1016/j.jpedsurg.2021.08.015. Epub 2021 Sep 4.
Neutropenic enterocolitis is uncommon but potentially life-threatening, with the cornerstone of treatment being medical management (MM), and surgical intervention reserved for clinical deterioration or bowel perforation. We hypothesized that the Shock Index Pediatric Age-Adjusted (SIPA) is elevated in patients who are at greatest risk for surgical intervention and mortality. We also sought to identify computed tomography (CT) findings associated with surgical intervention and mortality.
A single-center cancer registry was reviewed for neutropenic enterocolitis patients from 2006 -2018. Survival models compared patients with normal versus elevated SIPA throughout their hospitalizations for the time to surgical management (SM), as well as in-hospital mortality.
Seventy-four patients with neutropenic enterocolitis were identified; 7 underwent surgery. In-hospital mortality was 12% in MM and 29% in SM; mortality among patients with elevated SIPA was 4.7 times higher compared to those with normal SIPA (95% CI: 1.1, 19.83, p = 0.04). CT findings of bowel obstruction, pneumatosis, and a greater percentage of large bowel involvement were associated with surgical intervention (all ps < 0.05).
Select pre-operative CT findings were associated with need for operative management. Elevated SIPA was associated with increased mortality. Elevated SIPA in pediatric cancer patients with neutropenic enterocolitis may help to identify those with more severe disease and expedite beneficial interventions.
中性粒细胞减少性肠炎虽不常见，但具有潜在的致命性，其治疗的基石是医学管理（MM），手术干预仅保留给临床恶化或肠穿孔的患者。我们假设休克指数儿科年龄调整（SIPA）在最需要手术干预和死亡风险的患者中升高。我们还试图确定与手术干预和死亡相关的 CT 表现。
对 2006 年至 2018 年期间的中性粒细胞减少性肠炎患者进行了单中心癌症登记研究。生存模型比较了在整个住院期间 SIPA 正常与升高的患者接受手术管理（SM）的时间，以及院内死亡率。
共确定了 74 例中性粒细胞减少性肠炎患者，其中 7 例接受了手术。在 MM 中，院内死亡率为 12%，在 SM 中为 29%；SIPA 升高的患者死亡率比 SIPA 正常的患者高 4.7 倍（95%CI：1.1，19.83，p=0.04）。肠阻塞、气肿和大肠受累比例较高的 CT 表现与手术干预有关（均 p<0.05）。
术前 CT 表现与手术管理的需要有关。SIPA 升高与死亡率增加有关。中性粒细胞减少性肠炎的儿科癌症患者中 SIPA 升高可能有助于识别病情更严重的患者，并加快有益的干预措施。
