Background

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.

Methods

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.

Results

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).

Conclusion

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.

中文翻译：

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外科医生的困境：中性粒细胞减少性小肠结肠炎手术和死亡率的临床预测因素

背景

中性粒细胞减少性小肠结肠炎并不常见，但可能会危及生命，治疗的基石是医疗管理 (MM)，手术干预保留用于临床恶化或肠穿孔。我们假设休克指数儿科年龄调整 (SIPA) 在手术干预和死亡风险最大的患者中升高。我们还试图确定与手术干预和死亡率相关的计算机断层扫描 (CT) 结果。

方法

对 2006 年至 2018 年中性粒细胞减少性小肠结肠炎患者的单中心癌症登记进行了审查。生存模型比较了在整个住院期间 SIPA 正常和升高的患者到手术治疗 (SM) 的时间以及住院死亡率。

结果

确定了 74 名中性粒细胞减少性小肠结肠炎患者；7人接受了手术。MM 和 SM 的住院死亡率分别为 12% 和 29%；SIPA 升高患者的死亡率是 SIPA 正常患者的 4.7 倍（95% CI：1.1，19.83，p  = 0.04）。CT 发现肠梗阻、积气和更大比例的大肠受累与手术干预相关（所有 ps < 0.05）。

结论

选择的术前 CT 结果与手术管理的需要相关。升高的 SIPA 与死亡率增加有关。患有中性粒细胞减少性小肠结肠炎的儿科癌症患者的 SIPA 升高可能有助于识别患有更严重疾病的患者并加快有益的干预措施。