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TÜRKÇE
Poster - 252
C-Reactive Protein/Albumin Ratio Is a Prognostic Indicator for Predicting Surgical Intervention in Neonates with Necrotizing Enterocolitis
Ahsan Ali Ghauri 1, Muhammad Saleem 2, Nabila Talat 1, Muhammad Zubair Shoukat 1, Aziz Ahmed Chattha 1, Jamaal Butt 1
1 University of child health sciences, The Childrens Hospital, Lahore
2 Akhtar Saeed Medical & Dental College, Lahore
Background: Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. Early prediction of the need for surgical intervention remains challenging due to reliance on late clinical or radiological signs. The c-reactive protein and albumin ratio (CRP/Albumin) reflecting both inflammation and nutritional status, may serve as dynamic biomarker to guide timely surgical decision-making.
Methods: In this prospective cohort study at a tertiary care hospital, 66 neonates diagnosed with Bell’s stage I-IIIa NEC were enrolled over a year. CRP and Albumin levels were measured daily for three consecutive days, and CRP/Albumin ratio was calculated. Patients were grouped into progression trends: decreasing, increasing, stable or variable. Outcomes included surgical intervention and mortality. Statistical analysis included ROC curve analysis, sensitivity, specificity and comparative group analysis.
Results: Among 66 neonates (mean gestational age 37.2 ± 3.2 weeks), 42.4% required surgery. Neonates with an increasing CRP/Albumin ratio trend had a significantly higher rate of surgical intervention (89.5%) and mortality (26.3%) compared to those with a decreasing trend (8.1% surgery; 2.6% mortality) (p < 0.001). The CRP/Albumin ratio demonstrated excellent predictive accuracy for surgery, with AUC values of 0.926, 0.954, and 0.959 on Days 1, 2, and 3, respectively. Optimal cut-offs on Day 2 and 3 yielded sensitivity and specificities above 85%. Serial monitoring of the ratio outperformed single time-point measurements in prognostic value.
Conclusions: CRP/Albumin is a simple, reliable and cost-effective biomarker that can lead to early identification of neonates at risk of surgical intervention and poor outcomes in NEC. Monitoring its temporal progression, rather than relying on single measurements, appears to enhance its predictive accuracy and may support timely decision-making in clinical settings.