ASSOCIATION OF HEMATOLOGICAL BIOMARKERS AND HISTOPATHOLOGICAL FINDINGS WITH SEPSIS AND MORTALITY IN POSTOPERATIVE LAPAROTOMY PATIENTS IN ICU
Main Article Content
Keywords
Sepsis, hematological biomarkers, postoperative laparotomy, intensive care unit, mortality, procalcitonin, C-reactive protein, neutrophil-to-lymphocyte ratio, histopathology, D-dimer.
Abstract
Background
Sepsis early identification of high-risk patients is crucial for timely intervention and improved outcomes. Hematological biomarkers have shown potential in predicting sepsis and mortality, ‘but their role in critically ill surgical patients requires further evaluation’. ‘This study aimed to assess the association between hematological biomarkers and sepsis-related mortality in postoperative laparotomy patients’. Additionally, histopathological findings were analyzed to determine their impact on clinical outcomes.
Methods
A prospective observational study was conducted at Jinnah Medical College and Surgery Unit, and ICU Unit of DHQ/Mufti Mehmood Teaching Hospital (MMTI) Dera Ismail Khan, from January 2023 to January 2024, including 91 postoperative laparotomy patients admitted to the ICU. Demographic and clinical data were recorded, and laboratory biomarkers such as white blood cell count, neutrophil-to-lymphocyte ratio, platelet indices, C-reactive protein, and procalcitonin were analyzed. Coagulation markers including D-dimer and fibrinogen were also evaluated. Histopathological findings from surgical specimens were documented. ‘The incidence of sepsis, septic shock, and mortality was assessed, and statistical analysis was performed to determine significant associations’.
Results
Sepsis occurred in 60.4% of patients, with 33% developing septic shock. The 30-day mortality rate was 23.1%, while in-hospital mortality reached 30.8%. Elevated white blood cell count, neutrophil-to-lymphocyte ratio, C-reactive protein, and procalcitonin levels were significantly associated with sepsis development. Increased D-dimer and fibrinogen levels correlated with higher mortality rates. Histopathological analysis revealed that acute and chronic inflammation were the most common findings, while ischemic necrosis and malignancy were present in a subset of patients. ‘Prolonged ICU stay, mechanical ventilation, and higher SOFA and APACHE II scores were strongly linked to poor outcomes’.
Conclusion
Hematological biomarkers and histopathological findings play a crucial role in predicting sepsis and mortality in postoperative laparotomy patients. Early identification of high-risk cases through routine biomarker assessment can aid in timely interventions, potentially improving survival. Future research should focus on validating these findings in larger, multicenter studies to enhance critical care management strategies.
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Dr. Wasim Ahmad
Associate Professor, Department of Surgery, Gomal Medical College, Dera Ismail Khan, Pakistan
Dr. Abdut Tawab
Lecturer, Department of Pharmacology, Khyber Girls Medical College, Peshawar, Pakistan
Dr. Zahir Shah
Senior Lecturer, Department of Haematology (Pathology), Bacha Khan Medical College, Mardan, Pakistan
Dr. Akhtar Ghani
Assistant Professor, Department of General Surgery, Bannu Medical College, Khalifa Gul Nawaz Teaching Hospital, Bannu, Pakistan
Dr. Ronaq Zaman
Associate Professor, Department of Pathology, Kabir Medical College, Peshawar, Pakistan
Dr Muhammad Tariq
Associate Professor, Department of Pathology, Jinnah Medical College, Peshawar, Pakistan