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Background <p>The association between Hirschsprung-associated enterocolitis (HAEC) and the inflammatory burden index (IBI) remains unclear. This study aimed to delineate the dynamic perioperative IBI trajectories in patients with Hirschsprung disease (HSCR) using group-based trajectory modeling (GBTM) and to explore the association between different trajectory patterns and postoperative HAEC risk.</p> Methods <p>A total of 400 HSCR patients who underwent one-stage laparoscopic-assisted pull-through surgery at Children's Hospital of Chongqing Medical University were retrospectively enrolled. Complete blood count and C-reactive protein data collected at four perioperative time points (preoperative, postoperative days 1, 4, and 7) were used to calculate IBI. GBTM was applied to identify dynamic IBI trajectories. Multivariable logistic regression was performed to evaluate the independent association between distinct IBI trajectories and postoperative HAEC, with sensitivity analyses conducted using Bootstrap resampling and multiple assignment strategies.</p> Results <p>Three distinct perioperative IBI trajectories were identified: trajectory group 1 (mild postoperative rise followed by a slow decline, <i>n</i> = 75), trajectory group 2 (significant postoperative rise followed by a rapid decline, <i>n</i> = 246), and trajectory group 3 (significant postoperative rise followed by a slow decline, <i>n</i> = 79). The overall incidence of postoperative HAEC was 33.3% (133/400). Multivariable logistic regression revealed that, compared with trajectory group 1, patients in trajectory group 3 had a significantly increased risk of postoperative HAEC (OR = 3.42, 95% CI 1.42–8.23, <i>P</i> = 0.006). This finding remained robust after Bootstrap validation (OR = 3.42, 95% CI 1.33–8.80, <i>P</i> = 0.011) and sensitivity analyses.</p> Conclusion <p>This study delineated the dynamic perioperative IBI trajectories in HSCR patients and identified the “significant postoperative rise followed by a slow decline” trajectory as an independent risk factor for postoperative HAEC. Dynamic monitoring of IBI trajectories may aid in early identification of children at high risk for HAEC, but these findings require prospective validation before clinical implementation.</p>

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Association between inflammatory burden index trajectories and postoperative Hirschsprung-associated enterocolitis: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Zhengxing Jiang,
  • Wei Feng,
  • Hongtao Hu,
  • Xiaoping Wei,
  • Yinuo Jiang,
  • Jinping Hou,
  • Yi Wang

摘要

Background

The association between Hirschsprung-associated enterocolitis (HAEC) and the inflammatory burden index (IBI) remains unclear. This study aimed to delineate the dynamic perioperative IBI trajectories in patients with Hirschsprung disease (HSCR) using group-based trajectory modeling (GBTM) and to explore the association between different trajectory patterns and postoperative HAEC risk.

Methods

A total of 400 HSCR patients who underwent one-stage laparoscopic-assisted pull-through surgery at Children's Hospital of Chongqing Medical University were retrospectively enrolled. Complete blood count and C-reactive protein data collected at four perioperative time points (preoperative, postoperative days 1, 4, and 7) were used to calculate IBI. GBTM was applied to identify dynamic IBI trajectories. Multivariable logistic regression was performed to evaluate the independent association between distinct IBI trajectories and postoperative HAEC, with sensitivity analyses conducted using Bootstrap resampling and multiple assignment strategies.

Results

Three distinct perioperative IBI trajectories were identified: trajectory group 1 (mild postoperative rise followed by a slow decline, n = 75), trajectory group 2 (significant postoperative rise followed by a rapid decline, n = 246), and trajectory group 3 (significant postoperative rise followed by a slow decline, n = 79). The overall incidence of postoperative HAEC was 33.3% (133/400). Multivariable logistic regression revealed that, compared with trajectory group 1, patients in trajectory group 3 had a significantly increased risk of postoperative HAEC (OR = 3.42, 95% CI 1.42–8.23, P = 0.006). This finding remained robust after Bootstrap validation (OR = 3.42, 95% CI 1.33–8.80, P = 0.011) and sensitivity analyses.

Conclusion

This study delineated the dynamic perioperative IBI trajectories in HSCR patients and identified the “significant postoperative rise followed by a slow decline” trajectory as an independent risk factor for postoperative HAEC. Dynamic monitoring of IBI trajectories may aid in early identification of children at high risk for HAEC, but these findings require prospective validation before clinical implementation.