Hajibandeh Shahab, Hajibandeh Shahin, Evans Louis, Miller Bethany, Waterman Jennifer, Ahmad Suhaib Js, Hale Jay, Higgi Adnan, Johnson Bethan, Pearce Dafydd, Helmy Ahmed Hazem, Naguib Nader, Maw Andrew
Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom.
Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom.
World J Gastrointest Surg. 2023 Dec 27;15(12):2747-2756. doi: 10.4240/wjgs.v15.i12.2747.
Hajibandeh index (HI), derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin, is a modern predictor of peritoneal contamination and mortality in patients with acute abdominal pathology.
To validate the performance of HI in predicting the presence and nature of peritoneal contamination in patients with acute abdominal pathology in a larger cohort study and to synthesis evidence in a systematic review and meta-analysis.
The STROBE guidelines and the PRISMA statement standards were followed to conduct a cohort study (ChiCTR2200056183) and a meta-analysis (CRD42022306018), respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using receiver operating characteristic (ROC) curve analysis in the cohort study and using weighted summary area under the curve (AUC) under the fixed and random effects modelling in the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria were used for methodological quality assessment of the included studies.
A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 [95% confidence interval (CI): 0.76-0.82, < 0.0001], 0.76 (95%CI: 0.72-0.80, < 0.0001), and 0.83 (95%CI: 0.79-0.86, < 0.0001), respectively. The meta-analysis showed that the pooled AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 (95%CI: 0.75-0.83), 0.78 (95%CI: 0.74-0.81), and 0.80 (95%CI: 0.77-0.83), respectively.
The HI is a strong and accurate predictor of intraperitoneal contamination. Although the available evidence is robust, it is limited to the studies conducted by our evidence synthesis group. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
哈吉班德指数（HI）源自C反应蛋白、乳酸、中性粒细胞、淋巴细胞和白蛋白的综合水平，是急性腹部疾病患者腹膜污染和死亡率的现代预测指标。
在一项更大规模的队列研究中验证HI在预测急性腹部疾病患者腹膜污染的存在及性质方面的性能，并在系统评价和荟萃分析中综合证据。
分别遵循STROBE指南和PRISMA声明标准进行队列研究（ChiCTR2200056183）和荟萃分析（CRD42022306018）。所有因急性腹部疾病接受急诊剖腹手术的成年患者均符合条件。在队列研究中使用受试者工作特征（ROC）曲线分析评估HI的准确性，在荟萃分析中使用固定效应模型和随机效应模型下的加权曲线下面积（AUC）进行评估。采用诊断准确性研究质量评估2标准对纳入研究进行方法学质量评估。
共纳入1437例患者（队列研究700例，文献检索737例）。队列研究的ROC曲线分析显示，HI用于污染存在、脓性污染和粪性污染的AUC分别为0.79[95%置信区间（CI）：0.76 - 0.82，P < 0.0001]、0.76（95%CI：0.72 - 0.80，P < 0.0001）和0.83（95%CI：0.79 - 0.86，P < 0.0001）。荟萃分析显示，HI用于污染存在、脓性污染和粪性污染的合并AUC分别为0.79（95%CI：0.75 - 0.83）、0.78（95%CI：0.74 - 0.81）和0.80（95%CI：0.77 - 0.83）。
HI是腹腔内污染的强大且准确的预测指标。尽管现有证据确凿，但仅限于我们的证据综合小组所进行的研究。我们鼓励其他研究人员验证HI在预测腹腔内污染存在方面的性能，更重要的是在预测急诊剖腹手术后死亡率方面的性能。
