Inflammation Meets Nutrition: Combined Prognostic Value of Blood Based Biomarkers for Clinical Outcomes in Patients Hospitalized for Ileus

Abstract

Aim: Ileus is a common surgical emergency with a heterogeneous course and early identification of patients at risk of an adverse outcome is difficult. We aimed to evaluate the combined prognostic value of inflammation- and nutrition-based biomarkers in patients hospitalized for ileus and to test whether their importance differs by ileus type and outcome.Material and Methods: In a single center retrospective cohort of 192 adults with mechanical or paralytic ileus, admission values were used to calculate NLR, PLR, SII, PNI, albumin-to-creatinine (A/C) ratio, HALP score and C-reactive protein-to-albumin ratio (CAR). The primary outcome was a composite adverse outcome (surgery, intensive care unit [ICU] admission or in hospital mortality); a secondary analysis addressed ICU requirement within the mechanical subgroup. Analyses included ROC analysis, multivariable logistic regression, DeLong AUC comparison, bootstrap internal validation and decision curve analysis.Results: The composite outcome occurred in 91 patients (47.4%) and was strongly associated with mechanical ileus (86.8% vs 15.8%; p<0.001) and malignant etiology (p<0.001), whereas NLR and SII did not differ between groups. In the whole cohort model (optimism corrected AUC 0.911), independent predictors were mechanical type (OR 0.026, 95% CI 0.010–0.071; p<0.001), malignant etiology (OR 5.46, 95% CI 1.75–17.05; p=0.003) and CAR (OR 1.031, 95% CI 1.008–1.054; p=0.008). Within the mechanical subgroup, PNI was the only independent predictor of ICU requirement (OR 0.934, 95% CI 0.873–0.999; p=0.048; Cohen’s d=0.85).Conclusion: In ileus, biomarker prognostic value is outcome specific: CAR predicts the global adverse outcome, whereas PNI predicts ICU requirement in mechanical ileus. These inexpensive markers may complement clinical assessment but require external validation.