Journal of inflammation research · 2026
Association Between Perioperative Inflammatory Trajectories and Postoperative Hirschsprung-Associated Enterocolitis: Insights from Group-Based Trajectory Modeling.
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Jiang Zhengxing, Feng Wei, Hu Hongtao, Wei Xiaoping, Jiang Yinuo, Hou Jinping, Wang Yi
Аннотация
PURPOSE: This retrospective cohort study aimed to delineate the dynamic change trajectories of perioperative inflammatory markers in pediatric patients with Hirschsprung disease (HSCR) who underwent one-stage laparoscopic-assisted pull-through surgery at a single tertiary pediatric center using Group-Based Trajectory Modeling (GBTM), and to explore the association between different trajectory patterns and the risk of postoperative Hirschsprung-associated enterocolitis (HAEC).
METHODS: This study enrolled HSCR patients who underwent surgical treatment. Blood samples were collected at four perioperative time points (preoperative, postoperative days 1, 4, and 7) to calculate composite inflammatory markers such as the systemic inflammation response index (SIRI) and pan-immune inflammation value (PIV), as well as individual markers like white blood cell (WBC) and neutrophil counts. GBTM was employed to identify subgroups with similar inflammatory marker change trajectories. Multivariable logistic regression analysis was used to assess the association between different inflammatory trajectories and postoperative HAEC occurring within several years after surgery.
RESULTS: A total of 400 patients were included, of which 133 (33.3%) developed postoperative HAEC. Each inflammatory marker was categorized into 2-3 significantly distinct trajectory groups via GBTM. Multivariable logistic regression analysis revealed that for SIRI and PIV, compared to trajectory group 1 (low baseline with mild rise), patients in trajectory group 2 (moderate baseline with sharp rise and slow decline; SIRI: OR = 5.20, P = 0.011; PIV: OR = 4.75, P = 0.007) and trajectory group 3 (high baseline with sharp rise and slow decline; SIRI: OR = 4.73, P = 0.025; PIV: OR = 5.63, P = 0.008) had a significantly increased risk of postoperative HAEC. For WBC and neutrophils, trajectory group 2 (WBC: persistently high; neutrophils: low baseline with sharp rise and rapid decline) was an independent risk factor for postoperative HAEC (WBC: OR = 2.49, P = 0.004; neutrophils: OR = 2.53, P = 0.001).
CONCLUSION: Specific rising trajectories of SIRI, PIV, WBC, and neutrophils may serve as novel biomarkers for early identification of children at high risk for HAEC.
METHODS: This study enrolled HSCR patients who underwent surgical treatment. Blood samples were collected at four perioperative time points (preoperative, postoperative days 1, 4, and 7) to calculate composite inflammatory markers such as the systemic inflammation response index (SIRI) and pan-immune inflammation value (PIV), as well as individual markers like white blood cell (WBC) and neutrophil counts. GBTM was employed to identify subgroups with similar inflammatory marker change trajectories. Multivariable logistic regression analysis was used to assess the association between different inflammatory trajectories and postoperative HAEC occurring within several years after surgery.
RESULTS: A total of 400 patients were included, of which 133 (33.3%) developed postoperative HAEC. Each inflammatory marker was categorized into 2-3 significantly distinct trajectory groups via GBTM. Multivariable logistic regression analysis revealed that for SIRI and PIV, compared to trajectory group 1 (low baseline with mild rise), patients in trajectory group 2 (moderate baseline with sharp rise and slow decline; SIRI: OR = 5.20, P = 0.011; PIV: OR = 4.75, P = 0.007) and trajectory group 3 (high baseline with sharp rise and slow decline; SIRI: OR = 4.73, P = 0.025; PIV: OR = 5.63, P = 0.008) had a significantly increased risk of postoperative HAEC. For WBC and neutrophils, trajectory group 2 (WBC: persistently high; neutrophils: low baseline with sharp rise and rapid decline) was an independent risk factor for postoperative HAEC (WBC: OR = 2.49, P = 0.004; neutrophils: OR = 2.53, P = 0.001).
CONCLUSION: Specific rising trajectories of SIRI, PIV, WBC, and neutrophils may serve as novel biomarkers for early identification of children at high risk for HAEC.