İnflamasyon ve Nütrisyonun Buluşması: İleus Nedeniyle Hastaneye Yatırılan Hastalarda Kan Temelli Biyobelirteçlerin Klinik Sonuçlar için Kombine Prognostik Değeri

Abstract

Amaç: İleus, heterojen seyirli, sık görülen bir cerrahi acildir ve advers sonlanım riski taşıyan hastaların erken belirlenmesi güçtür. Bu çalışmada, ileus nedeniyle hastaneye yatırılan hastalarda inflamasyon ve nütrisyon temelli biyobelirteçlerin kombine prognostik değerini değerlendirmeyi ve öneminin ileus tipine ve sonlanıma göre değişip değişmediğini araştırmayı amaçladık.

Gereç ve Yöntemler: Mekanik veya paralitik ileus tanısıyla yatırılan 192 erişkinden oluşan tek merkezli retrospektif kohortta, başvuru değerlerinden NLR, PLR, SII, PNI, albümin/kreatinin (A/C) oranı, HALP skoru ve C-reaktif protein/albümin oranı (CAR) hesaplandı. Birincil sonlanım composite advers sonlanımdı (cerrahi, yoğun bakım ünitesi [YBÜ] yatışı veya hastane içi mortalite); ikincil analizde mekanik alt grupta YBÜ ihtiyacı değerlendirildi. Analizlerde ROC analizi, çok değişkenli lojistik regresyon, DeLong AUC karşılaştırması, bootstrap iç validasyon ve karar eğrisi analizi kullanıldı.

Bulgular: Composite sonlanım 91 hastada (%47,4) görüldü ve mekanik ileus (%86,8'e karşı %15,8; p<0,001) ile malign etiyolojiyle (p<0,001) güçlü ilişkiliyken, NLR ve SII gruplar arasında farklı değildi. Tüm kohort modelinde (optimism-düzeltilmiş AUC 0,911) bağımsız prediktörler mekanik tip (OR 0,026, %95 GA 0,010–0,071; p<0,001), malign etiyoloji (OR 5,46, %95 GA 1,75–17,05; p=0,003) ve CAR (OR 1,031, %95 GA 1,008–1,054; p=0,008) idi. Mekanik alt grupta YBÜ ihtiyacının tek bağımsız prediktörü PNI'ydi (OR 0,934, %95 GA 0,873–0,999; p=0,048; Cohen d=0,85).

Sonuç: İleusta biyobelirteçlerin prognostik değeri sonlanıma özgüdür: CAR genel advers sonlanımı, PNI ise mekanik ileusta YBÜ ihtiyacını öngörür. Bu ucuz belirteçler klinik değerlendirmeyi tamamlayabilir ancak dış validasyon gerektirir.

Keywords

• İleus
• bağırsak tıkanıklığı
• prognostik nütrisyonel indeks
• C-reaktif protein-albümin oranı
• sistemik immün-inflamasyon indeksi
• risk sınıflandırması

Ethical Statement

Bu çalışma, Bolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylanmış (tarih: 07.04.2026, karar no: 2026/160) ve Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Çalışmanın retrospektif bir tasarımda gerçekleştirilmesi nedeniyle, bilgilendirilmiş onam şartından feragat edilmiştir.

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.

Keywords

• Ileus
• bowel obstruction
• prognostic nutritional index
• C-reactive protein-to-albumin ratio
• systemic immune-inflammation index
• risk stratification

Ethical Statement

This study was approved by the Bolu Abant Izzet Baysal University Medical Faculty Ethics Committee (date: 07.04.2026, decision no: 2026/160) and was conducted in accordance with the principles of the Declaration of Helsinki. Given the retrospective design, the requirement for informed consent was waived.

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