Utility of Pan-Immune-Inflammatory Value and Lactate for Determining Surgical Indications for Portal Venous Gas and Intestinal Pneumatosis

<p>Purpose: Recent advances in CT have resulted in an increasing number of patients with portal venous gas and/or intestinal pneumatosis being treated conservatively. However, in clinical practice, it is often difficult to determine whether surgery is appropriate. This retrospective study was performed to identify predictive factors for surgical indications in patients with portal venous gas and intestinal pneumatosis. Materials and Methods: The subjects were 26 patients diagnosed with portal venous gas and/or intestinal pneumatosis between 2002 and 2022. Clinical findings, including neutrophil-to-lymphocyte ratio and pan-immune-inflammatory value (PIV), were compared between two groups according to their indications for surgery. Results: Compared with the group without an indication for intestinal resection, CT showed that patients with indications for intestinal resection had a high level of peritoneal irritation and high attenuation of the intestinal wall. However, CT showed no significant differences in ascites and intraperitoneal air between the groups. Preoperative white blood cell count, C-reactive protein, creatine kinase and neutrophil-to-lymphocyte ratio were not associated with an indication for intestinal resection. However, higher PIV and serum lactate were associated with this indication. Receiver operating characteristic curve analysis showed that the optimal cut-off values for PIV and serum lactate were 373 (area under the curve, 0.75; sensitivity, 58.3%; specificity, 92.9%) and 1.9 mmol/l (area under the curve, 0.82; sensitivity, 90.9%; specificity, 58.3%), respectively. Conclusion: PIV and serum lactate could help to determine the surgical indication for portal venous gas and intestinal pneumatosis.</p>