[Evaluation of the SNAPPE-II and Metabolic Disorder Index as predictors of mortality in necrotizing enterocolitis].

Aim: Several scores have been proposed to predict the outcome of patients with Necrotizing Enterocolitis (NEC). We compare the SNAPPE-II (Score for Neonatal Acute Physiology-Perinatal Extension-II) and the Metabolic Derangement Index for the outcome of mortality in neonates with NEC.

Methods: 99 patients diagnosed of NEC were reviewed retrospectively. The SNAPPE-II and ITM were applied at three moments: when the first diagnosis was made (T0), first evaluation by a pediatric surgeon (T1), and 24 hours after surgery (T2). ROC curves were obtained for each score. Comparison between curves of the area under the curve (AUC) was done with the method proposed for Hanley and McNeil for related curves.

Results: 34 patients underwent surgery. 17 patients died. The AUCs to predict mortality for SNAPPE-II were: 0.68 (CI 95%: 0,55-0,80) at T0; 0,62 (CI 95%: 0,43-0,81) at T1 ; 0.72 (CI 95%: 0,54-0,90) at T2. The AUCs for the metabolic derangement index were 0.67 (CI 95%: 0,54-0,82) at T0; 0,71 (CI 95%: 0,52-0,89) at T1 ; 0.78 (CI 95%: 0,62-0,94) at T2. No differences between AUCs were found using the method proposed by Hanley and McNeil for related curves (p=0,8 at T0; p=0,5 at T1; p=0,6 at T2).

Conclusions: No statistically significant differences were found between the diagnostic performance of the SNAPPE-II and the metabolic derangement index to predict mortality in NEC. The diagnostic performance of both scores is lower than 80%, so its value might be limited.