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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive value of Hajibandeh index in determining peritoneal contamination in acute abdomen: A cohort study and meta-analysis
Shahab Hajibandeh, Shahin Hajibandeh, Louis Evans, Bethany Miller, Jennifer Waterman, Suhaib JS Ahmad, Jay Hale, Adnan Higgi, Bethan Johnson, Dafydd Pearce, Ahmed Hazem Helmy, Nader Naguib, Andrew Maw
Shahab Hajibandeh, Louis Evans, Bethany Miller, Jennifer Waterman, Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
Shahin Hajibandeh, Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
Suhaib JS Ahmad, Department of General Surgery, Ysbyty Gwynedd, Bangor LL57 2PW, United Kingdom
Jay Hale, Adnan Higgi, Bethan Johnson, Dafydd Pearce, Ahmed Hazem Helmy, Nader Naguib, Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
Andrew Maw, Department of General Surgery, Glan Clwyd Hospital, Rhyl LL18 5UJ, United Kingdom
Co-first authors: Shahab Hajibandeh and Shahin Hajibandeh.
Author contributions: Hajibandeh S contributed to the conception and design of this study; Evans L, Miller B, Waterman J, Hale J, Higgi A, Johnson B, and Pearce D participated in the data collection; Hajibandeh S and Hajibandeh S took part in the analysis and interpretation of this manuscript, and wrote the article; all authors contributed to the critical revision of the article of this study; and all authors approved the final article.
Institutional review board statement: The study was conducted in accordance with institutions’ policies and internal arrangements approved by local Clinical Governance Unit. The study was a retrospective cohort study and meta-analysis involving non-identifiable data from hospital and electronic databases, hence patients’ consent and approval by Research Ethics Committees were not required.
Informed consent statement: The study was a retrospective cohort study and meta-analysis involving non-identifiable data from hospital and electronic databases, hence patients’ consent was not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data and materials related to this study will be available upon reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shahab Hajibandeh, MBChB, MRCS, Doctor, Researcher, Surgeon, Department of General Surgery, University Hospital of Wales, Heath Park Way, Cardiff CF14 4XW, United Kingdom.
shahab_hajibandeh@yahoo.com
Received: September 29, 2023
Peer-review started: September 29, 2023
First decision: November 1, 2023
Revised: November 1, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 27, 2023
Processing time: 88 Days and 15.3 Hours
BACKGROUND
Hajibandeh index (HI), derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin, is a modern predictor of peritoneal contamination and mortality in patients with acute abdominal pathology.
AIM
To validate the performance of HI in predicting the presence and nature of peritoneal contamination in patients with acute abdominal pathology in a larger cohort study and to synthesis evidence in a systematic review and meta-analysis.
METHODS
The STROBE guidelines and the PRISMA statement standards were followed to conduct a cohort study (ChiCTR2200056183) and a meta-analysis (CRD42022306018), respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using receiver operating characteristic (ROC) curve analysis in the cohort study and using weighted summary area under the curve (AUC) under the fixed and random effects modelling in the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria were used for methodological quality assessment of the included studies.
RESULTS
A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 [95% confidence interval (CI): 0.76-0.82, P < 0.0001], 0.76 (95%CI: 0.72-0.80, P < 0.0001), and 0.83 (95%CI: 0.79-0.86, P < 0.0001), respectively. The meta-analysis showed that the pooled AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 (95%CI: 0.75-0.83), 0.78 (95%CI: 0.74-0.81), and 0.80 (95%CI: 0.77-0.83), respectively.
CONCLUSION
The HI is a strong and accurate predictor of intraperitoneal contamination. Although the available evidence is robust, it is limited to the studies conducted by our evidence synthesis group. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
Core Tip: Hajibandeh index (HI), derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin, can strongly predict presence and nature of peritoneal contamination in acute abdomen. The evidence is robust but limited to studies by our evidence synthesis group, hence we encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
