C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis
Document Type
Article
Publication Date
7-1-2021
Abstract
Purpose 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). Methods 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). Results 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. Conclusions 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.
Keywords
Necrotizing enterocolitis, C-reactive protein, Albumin, Surgery, Mortality, Outcomes
Divisions
fac_med
Publication Title
Pediatric Surgery International
Volume
37
Issue
7
Publisher
Springer Verlag
Publisher Location
ONE NEW YORK PLAZA, SUITE 4600, NEW YORK, NY, UNITED STATES