Can direct bilirubin-to-lymphocyte ratio predict surgery for pediatric adhesive small bowel obstruction




Mustafa Azizoğlu, Clinic of Pediatric Surgery, Esenyurt Necmi Kadıoğlu State Hospital, Istanbul, Turkey
Serkan Arslan, Department of Pediatric Surgery, Dicle University Medical School, Diyarbakır, Turkey
Tahsin O. Kamci, Department of Pediatric Surgery, Dicle University Medical School, Diyarbakır, Turkey
Erol Basuguy, Department of Pediatric Surgery, Dicle University Medical School, Diyarbakır, Turkey
Bahattin Aydoğdu, Department of pediatric surgery, Balıkesir University Medical School, Balıkesir. Turkey
Müsemma A. Karabel, Department of Pediatrics and Pediatric Pneumology, Dicle University Medical School, Diyarbakır, Turkey
Mehmet H. Okur, Department of Pediatric Surgery, Dicle University Medical School, Diyarbakır, Turkey


Objective: Estimating which patients might require surgical intervention is crucial. Patients with complete bowel obstructions exhibit disrupted enterohepatic cycles of bile and bacteremia due to bacterial translocation. The goal of this study was to develop a prediction index using laboratory inflammatory data to identify patients who may need surgery. Materials and methods: The patients were divided into two groups based on their management strategy: Non-operative management (Group 1) and surgical management (Group 2). Results: The indirect bilirubin, direct bilirubin, and total bilirubin were significantly higher in Group 2 than in Group 1 (p = 0.001, p < 0.001, and p < 0.001, respectively). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-NLR (PNLR), and direct bilirubin-to-lymphocyte ratio (DBR) were significantly higher in Group 2 compared to Group 1 (p = 0.041, p = 0.020, and p < 0.001, respectively). In group 2, 78% have viable bowels. Resection was performed in 40% of cases, with 12% mortality and a 10-day average hospital stay. DLR performs the best overall accuracy (72%), demonstrating a well-balanced sensitivity (62%) and specificity (81%). Conclusions: This study suggested that DBR is a more accurate predictive index for surgical intervention in pediatric adhesive small bowel obstruction patients compared to NLR and PNLR, providing valuable guidance for treatment strategies.



Keywords: Neutrophil-to-lymphocyte ratio. Platelet-to-neutrophil-to-lymphocyte ratio. Direct bilirubin-to-lymphocyte ratio. Adhesive small bowel obstruction.