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NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A PREDICTOR OF THE NEED FOR SURGICAL TREATMENT IN CHILDREN´S INTUSSUSCEPTION.

BACKGROUND
Neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory marker in abdominal pathologies. Ileocolic intussusception (ICI) involves a progressive intestinal inflammation, and the effectiveness of non-surgical treatment (enema) might be related to the inflammation degree, although no previous studies have investigated this relationship. Our aim is to identify predictors of the need for surgical treatment in ICI.


METHODS
A single-center, retrospective, case-control study was performed in children with ICI, who were treated with initial non-surgical management between 2005 and 2019, Patients were divided in 2 groups: A (effective enema) and B (need for surgery). Admission demographic, clinical and laboratory data were analyzed. Specificity and sensitivity of the different parameters as predictors of the need for surgical treatment were determined by receiver operating characteristic (ROC) curves.


RESULTS
511 patients were included (410 group A; 101 group B), without statistically significant demographic differences. Group B presented significantly higher frequency of vomiting, bloody stools and longer median time since symptoms onset (24 vs. 8 hours; p<0.001). Group B presented higher median laboratory inflammatory markers than group A: NLR (6.8 vs. 1.8; p<0.001), neutrophils (10,148 vs. 7,468; p<0.001), CRP (28.2 vs.4.7; p<0.001). In ROC curve analysis, NLR had an area under the curve (AUC) of 0.925, higher than neutrophil count (0.776; p=0.001), CRP (0.670; p=0.001), and time since symptoms onset (0.673; p=0.001). It was estimated a cut-off point of NLR>4.52 (sensitivity: 73.2%; specificity: 94.5%). Conclusion: High NLR values imply a high degree of bowel inflammation and might anticipate the need for surgical treatment in ICI in children.