Effect of serum creatinine changes on surgical timing and prognosis in progressive necrotizing Enterocolitis.

Introduction: To explore the effect of elevated serum creatinine on the timing of surgery and prognosis in patients with progressive necrotizing enterocolitis.

Methods: A total of 367 children who underwent surgery for necrotizing enterocolitis(NEC) from May 2008 to April 2024 were collected, and 156 patients with incomplete data were excluded. Among the remaining 211 surgical cases, 168 patients (before August 14, 2019) were included in the statistical analysis, and 43 patients (after August 14, 2019) were used as the validation set. The basic data of the patients, including gender, gestational age, birth weight, age at onset, the length of ICU stay, cardiac ultrasound results, Bell's stage, whether they were small for gestational age, urine volume in the 24 h before operation, preoperative blood routine (white blood cells, platelets), C-reactive protein (CRP), blood gas analysis, renal function (serum creatinine, blood urea nitrogen) and weight at the time of surgery were collected for statistical analysis.

Results: A total of 98 (26.7%) patients died among the 367 patients, of which 47 (48%) had acute kidney injury. Between the 211 patients included in the statistical analysis, 47 (22.3%) died, and among the 168 patients in the data set, 39 (23.2%) died. Of the 43 patients in the validation set, 8 (18.6%) died. There were statistically significant differences in birth weight, length of ICU stay, preoperative serum creatinine, urine volume, white blood cell count, lactate, HCO3-, heart malformations, and small for gestational age status in the collected data, p < 0.05. After ROC-AUC analysis, it was found that when serum creatinine cutoff = 60.5ummol/L, the area under the curve AUC = 0.842, sensitivity = 0.795, specificity = 0.705, and after COX regression analysis, the serum creatinine HR value = 7.242, 95% CI [2.852-18.388]. Log Rank in the K-M curve of SGA = 42.958, p < 0.001. Among the 43 cases in the validation set, 35 survived, sensitivity = 0.75, specificity = 0.771.

Conclusion: In addition to clinical manifestations, imaging, and infection indicators as factors for determining surgical indications in progressive NEC, more active intervention should be considered when serum creatinine begins to rise to 60.5ummol/L.

Level of evidence: Level III Retrospective Comparative Cohort Study.