Preoperative Hemoglobin-albumin-lymphocyte -platelet [halp] Score Utility in Predicting Surgical Outcomes of Pediatric Intussusception at Kenyatta National Hospital

Abstract

BACKGROUND Intussusception is the leading cause of intestinal obstruction in infancy and early childhood. Postoperative mortality in Sub-Saharan Africa is as high as 13% There is limited research on preoperative indices that aim at predicting the surgical outcomes of paediatric intussusception. A comprehensive biomarker composed of preoperative levels of haemoglobin, albumin, lymphocytes and platelet levels (HALP) score has been shown to predict unfavourable outcomes in several surgical as well as medical conditions.This research attempted to determine the prognostic value of the HALP score to predict surgical outcomes of children with intussusception who have undergone surgical intervention at Kenyatta National Hospital (KNH).Predicting the surgical outcomes can assist in preoperative planning of patient care after surgical intervention and enable informative counselling to parents on the expected outcomes. STUDY OBJECTIVE To determine the prognostic significance of preoperative HALP Score in patient with intussusception undergoing surgery at KNH. METHODOLOGY This was a retrospective study conducted at KNH. Data was obtained from medical records of all children below 13 years of age following surgical management for intussusception between January 2017 to January 2024. Using a Data collection tool, information on patient demographics, preoperative values of haemoglobin, albumin, absolute lymphocyte count, platelet counts taken at KNH Laboratories, postoperative complications as graded in the Clavien-Dindo (CD) classification, duration of ICU stay, and overall length of hospitalisation were recorded. DATA MANAGEMENT AND ANALYSIS Collected data was entered, coded and analyzed by the use of statistical package SPSS Version 29.0.2(20) Using Receiver operating characteristic (ROC) curves optimal HALP Score cutoffs were obtained, and patients classified into high and low HALP Score groups. AUC to evaluate the capability to detect postoperative complications These complications will be recorded as per the Clavien Dindo Classification and severity categorized as minor or major complications. Length of hospital stay was grouped into normal and prolonged depending on deviation from the median. Correlation analysis was done using Spearman’s rank ordered correlation or phi

coefficient was carried out as indicated. A p value of 0.05 will serve as cut off for statistical significance. RESULTS A total of 395 cases were retrieved from KNH medical records department. Gender demographics included 113 cases (52.6%) of males and 102 (47.4%) females with a male to female ratio of 1.1 Cases enrolled ranged from 1 to 108 months with the median of presentation at 7 months (IQR of 6 to 11). Approximately 81.4% of cases were below 12 months of age. The peak age incidence was in the age group of 5 to 8 months with the highest incidence at 6 months. Up to 22.4% were below the 5th percentile hence categorized as underweight. Those who were well nourished lied between the 5th and 85th percentile had a cumulative percentage of 64.3%. Postoperative complications occurred overall in 53.9% of patients. The most frequent complication was anaemia requiring blood transfusion, occurring in 39.5% of patients. The length of hospital stay (LOHS) revealed a median of 7 days. The in-hospital mortality rate was recorded at 11.6%. The findings of our research indicate that HALP score exhibited a very strong negative correlation coefficient of -0.813. Moreover, there was a moderate negative correlation between HALP scores and both the length of hospital stay (-0.661) and mortality (-0.571). The tool demonstrated high diagnostic accuracy in forecasting postoperative complications, as reflected by an AUC of 0.869 and the cut-off value of HALP score at maximal Youden index was at 33.91. Low HALP scores had a strong negative correlation with poor surgical outcomes. CONCLUSION HALP score serves as a valuable tool for assessing the immunonutritive status of patients and predicting postoperative complications, length of hospital stay as well as mortality. Low HALP scores of below 33.91 predicted a high probability of poor surgical outcomes. STUDY UTILITY The study's findings will aid in the creation of local protocols, guidelines, and policy documents for managing intussusception. Evidence-based guidelines can be developed for referring highrisk patients and determining admission criteria for Intensive Care Units. Additionally, the study will promote an informed approach to counseling parents or legal guardians regarding anticipated surgical outcomes and the expected course of treatment