Inflammatory markers are closely related to the diagnosis and prediction of severity of adult incarcerated inguinal hernia

Inflammatory markers are closely related to the diagnosis and prediction of severity of adult incarcerated inguinal hernia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Inflammatory markers are closely related to the diagnosis and prediction of severity of adult incarcerated inguinal hernia Xigui Tian, Caihao Tang, Jiaming Lan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7658202/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Surgery → Version 1 posted 17 You are reading this latest preprint version Abstract Background Incarcerated inguinal hernia can further develop into strangulated inguinal hernia, and their diagnosis is challenging. This article aims to explore whether inflammatory markers in the blood are helpful in the diagnosis of incarcerated inguinal hernia and in predicting the severity of incarcerated inguinal hernia. Methods We selected patients with incarcerated inguinal hernia who underwent surgical treatment between January 1, 2018 and December 31, 2024. All patients completed blood tests before surgery. All patients were divided into two groups, bowel resection group and no bowel resection group. Results A total of 203 patients were included in the study, including 78 patients in the intestinal resection group. There were no statistically significant differences in sex, admission season, recurrent hernia, hernia side, incarcerated organ, and in-hospital time between the two groups. There are statistical differences in type of hernia, WBCC, NE%, NLR, CRP, and serum Na + between the two groups. Conclusion WBCC, NE%, NLR, and CRP values can be used to diagnose incarcerated inguinal hernia. Combining inflammatory markers to predict the severity of incarcerated inguinal hernia is highly effective. incarcerated groin hernia bowel resection inflammatory markers Figures Figure 1 Introduction Inguinal hernia is a common surgical disease, and for adult patients, surgical treatment is the most effective treatment method.[ 1 ] As the most common elective surgery worldwide, over 20 million people undergo inguinal hernia surgery every year for treatment.[ 2 ] However, when the abdominal organs enter the hernia sac and cannot self-reduce due to the narrowing of the outer ring, they remain inside the hernia sac, leading to disturbance of blood circulation, which is called incarcerated inguinal hernia. This is a disease that requires emergency surgery, with approximately 5–15% of patients with inguinal hernia experiencing incarceration. [ 3 – 5 ] Incarcerated inguinal hernia is a common cause of intestinal obstruction.[ 6 ] If the incarcerated inguinal hernia can be relieved in time, the affected intestinal tract can return to normal, and intestinal obstruction can be cured. If the incarceration cannot be relieved in a timely manner, the increasing pressure on the intestinal tract and mesentery can reduce arterial blood flow, ultimately leading to complete blockage and the formation of strangulated inguinal hernia. At this point, the pulsation of the mesenteric artery disappears, and the intestinal wall gradually loses its luster, elasticity, and peristaltic ability, ultimately leading to intestinal necrosis. The hospitalization time of patients with intestinal necrosis will be significantly increased, and postoperative complications will be higher, about 6% -43%,[ 7 – 10 ] with a mortality rate of 1% -7%.[ 5 , 8 , 11 ] When the intestinal blood supply of incarcerated inguinal hernia is good, manual reduction is an acceptable treatment option, especially for patients with high anesthesia risk.[ 3 ] Exploratory laparotomy and laparoscopic exploration are common surgical methods for incarcerated inguinal hernia. If preoperative judgment requires intestinal resection, it will affect the choice of surgical method by the surgeon.[ 12 ] Therefore, preoperative assessment of whether intestinal ischemic necrosis has occurred in incarcerated inguinal hernia is helpful for clinical doctors in diagnosis and treatment selection. For example, advanced age, female gender, and type of inguinal hernia are common high-risk factors for intestinal resection of incarcerated inguinal hernia.[ 6 , 13 , 14 ] Inflammatory markers are used to diagnose and assess the severity of acute appendicitis.[ 15 – 17 ] This retrospective study aims to predict the severity of incarcerated inguinal hernia by analyzing different inflammatory markers. Material and Methods Patients and data collection Patients diagnosed with incarcerated inguinal hernia and undergoing surgical treatment in our hospital will be selected. We retrieved hospitalized patients related to the period from January 1, 2018 to December 31, 2024. This study has obtained the approval of the Ethics Committee of Liangping District People's Hospital in Chongqing. All patients diagnosed with incarcerated inguinal hernia will be selected by us, and we will confirm the diagnosis based on surgical records. We will select those who meet the following criteria: age > 18 years, be treated surgically, not receiving antibiotic treatment before admission. The following situations will be ruled out by us: successful manual repositioning and scheduled surgery, the contents of the incarcerated hernia are the omentum, not receiving surgical treatment within 12 hours of admission, incarcerated inguinal hernia that occurred during hospitalization, have blood system diseases and other infectious diseases. All data comes from the patient's medical records, and we collected the following data: age, gender, month of onset, the time interval between symptom onset and hospitalization, the time interval between hospitalization and surgery, preoperative white blood cell count (WBCC), percentage of neutrophils (NE%), C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), serum Na + , type of hernia, hernia side, incarcerated organ, recurrent hernia, bowel resection. At our institution, patients will have their blood samples drawn upon admission. And sudden irreversible mass in the inguinal region accompanied by pain is defined as the time of symptom onset. We will designate March 21st to September 22nd as spring and summer, and September 23rd to March 20th of the following year as autumn and winter. When the patient is diagnosed with incarcerated inguinal hernia and there are no signs of peritonitis, we will perform manual reduction with the patient's informed consent. If the manual reset fails, we will perform emergency surgery on the patient. Blood samples are measured by an automated hematology analyzer (Sysmex NX-10) and a fully automated electrolyte analyzer (LABOSPECT 008). In our institution, we consider WBCC, NE%, and CRP as common inflammatory markers, with abnormal reference upper limits of 9.5*10 9 /L, 75.0%, and 10.0mg/L, respectively. We found that NLR, as an inflammatory marker, is also used for the diagnosis of incarcerated inguinal hernia.[ 6 , 18 , 19 ] The reference lower limit of serum Na + is 137.0 mmol/L. We decided whether to perform intestinal resection based on intraoperative exploration of intestinal ischemia, and divided the patients into two groups: bowel resection group and no bowel resection group. We explore sensitive indicators of intestinal necrosis by analyzing and comparing data from two groups of patients. Statistical analysis We used SPSS 24.0 (IBM, Armonk, NY, USA) software to analyze all the research data. Categorical variables are analyzed using percentages for descriptive statistics, and Chi-square test or Fisher's exact tests are used for analysis depending on the situation. Continuous variables with normal distribution are represented by mean ± (standard deviation), maximum and minimum values, and then independent sample t-test is used to detect whether there is a difference between the two groups. We use ROC curve to determine the optimal critical value of inflammatory markers for intestinal necrosis. The maximum value of the Youden index corresponds to the optimal diagnostic threshold, which is the cutoff value. We will calculate the area under the curve (AUC), ROC curve, and 95% confidence interval (CI) of AUC. In our analysis process, p < 0.05 will be considered statistically significant. Results According to the inclusion and exclusion criteria, a total of 203 patients were selected for this study. Among them, there were more male patients than female patients, with 117 male patients (57.6%) and 86 female patients (42.4%). Some factors (categorical variables) that may affect intestinal resection for incarcerated inguinal hernia are presented in Table 1 . There were 78 patients in the intestinal resection group, including 42 male patients (53.8%) and 36 female patients 36(46.2%). There were 125 patients in the non-intestinal resection group, including 75 male patients (60.0%) and 50 female patients (40.0%). There is no statistical difference between these two groups (p = 0.388). There was no statistical difference between the two groups in terms of the season of onset, previous occurrence of inguinal hernia, hernia side, incarcerated organ, and time from admission to surgery (p = 0.798, p = 0.748, p = 0.122, p = 0.078, p = 0.260). Type of hernia, WBCC, NE%, CRP, NLR, and serum Na + showed statistical differences between the two groups(p < 0.05). In the intestinal resection group, there were 56 cases of femoral hernia patients, accounting for a relatively high proportion of 71.8%. In the non-intestinal resection group, there were 70 cases of indirect hernia patients, accounting for a relatively high proportion of 56.0%. Table 1 Univariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (categorical variables) Characteristics Bowel resection n = 78 No bowel resection n = 125 P value Total n = 203 Sex Male 42(53.8%) 75(60.0%) 117(57.6%) Female 36(46.2%) 50(40.0%) 0.388 86(42.4%) Admission season Spring and summer 36(46.2%) 60(48.0%) 96(47.3%) Autumn and winter 42(53.8%) 65(52.0%) 0.798 107(52.7%) Type of hernia Indirect hernia 22(28.2%) 70(56.0%) 92(45.3%) Femoral hernia 56(71.8%) 50(40.0%) <0.001 106(52.2%) Direct hernia 0(0.0%) 5(4.0%) 5(2.5%) Recurrent hernia Yes 3(3.8%) 6(4.8%) 9(4.4%) No 75(96.2%) 119(95.2%) 0.748 194(95.6%) Hernia side Left 27(34.6%) 57(45.6%) 84(41.4%) Right 51(65.4%) 68(54.4%) 0.122 119(58.6%) Incarcerated organ Small bowel 76(97.4%) 114(91.2%) 190(93.6%) Colon 2(2.6%) 11(8.8%) 0.078 13(6.4%) WBCC (10 9 /L) ≤ 9.5 39(50.0%) 88(70.4%) 127(62.6%) >9.5 39(50.0%) 37(29.6%) 0.003 76(37.4%) NE% ≤ 75.0 7(9.0%) 59(47.2%) 66(32.5%) >75.0 71(91.0%) 66(52.8%) 10 53(67.9%) 15(12.0%) 8.2 54(69.2%) 31(24.8%) 137.0 60(76.9%) 120(96.0%) 6.0 31(39.7%) 40(32.0%) 0.260 71(35.0%) WBCC: preoperative white blood cell count, NE%: percentage of neutrophils, CRP:C-reactive protein, NLR: neutrophil/lymphocyte ratio Univariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (continuous variable) is shown in Table 2 . The average age of the intestinal resection group was 72.90 ± 8.33 years, while the average age of the non-intestinal resection group was 68.08 ± 11.74 years. The age of the intestinal resection group is higher than that of the non-intestinal resection group, and there is a statistical difference between them(p < 0.05). There were also statistical differences in duration of incarceration, WBCC, NE%, CRP, and NLR between the two groups(p < 0.05). The duration of incarceration, WBCC, NE%, CRP, and NLR values of the intestinal resection group were significantly higher than those of the non-intestinal resection group. Finally, we can observe that the range of maximum and minimum values in each group is quite large. Table 2 Univariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (continuous variable) Characteristics Bowel resection n = 78 No bowel resection n = 125 P value Age (years, mean ± SD, (min, max)) 72.90 ± 8.33(46,88) 68.08 ± 11.74(35,92) 0.002 Duration of incarceration (h, mean ± SD, (min, max)) 62.10 ± 58.50(3,288) 33.12 ± 48.49(2,240) <0.001 WBCC (10 9 /L, mean ± SD, (min, max)) 9.81 ± 3.33(2.41,15.87) 8.11 ± 3.04(2.95,17.26) <0.001 NE% (mean ± SD, (min, max)) 83.64 ± 6.70(65.7,95.2) 75.16 ± 10.37(54.1,93.7) <0.001 NLR (mean ± SD, (min, max)) 12.30 ± 8.15(2.88,40.56) 7.03 ± 5.83(1.58,32.34) <0.001 CRP (mg/L, mean ± SD, (min, max)) 43.63 ± 44.11(10,175.57) 13.37 ± 12.54(10,96.91) <0.001 SD: standard deviation The sensitivity of inflammatory markers in the diagnosis of whether to perform intestinal resection based on surgical results is shown in Table 3 . The increase of individual inflammatory markers, such as WBCC, NE%, CRP, and NLR, has higher sensitivity in the intestinal resection group, but lower sensitivity in the non-intestinal resection group. And we analyzed the situation where several inflammatory markers were either normal or elevated simultaneously. When several inflammatory markers are normal at the same time, it has extremely high sensitivity for diagnosing patients who have not undergone intestinal resection surgery. When the values of several inflammatory markers increase simultaneously, it has extremely high sensitivity for diagnosing patients undergoing intestinal resection surgery. It is worth mentioning that even if inflammatory markers are normal or elevated at the same time, it cannot accurately predict whether intestinal resection surgery will be performed. Table 3 According to the surgical results, the sensitivity of inflammatory markers (WBCC, NE%, NLR, and CRP) to elevated or simultaneously elevated or simultaneously normal is determined Bowel resection n = 78 No bowel resection n = 125 Total n = 203 Elevated WBCC 39(50.0%) 37(29.6%) 76(37.4%) Elevated NE% 71(91.0%) 66(52.8%) 137(67.5%) Elevated NLR 54(69.2%) 31(24.8%) 85(41.9%) Elevated CRP 53(67.9%) 15(12.0%) 68(33.5%) Normal WBCC, NE%, CRP 3(3.8%) 45(36.0%) 48(23.6%) Normal WBCC, NE%, NLR, CRP 2(2.6%) 45(36.0%) 47(23.2%) Elevated WBCC, NE%, CRP 30(38.5%) 3(2.4%) 33(16.3%) Elevated WBCC, NE%, NLR, CRP 27(34.6%) 1(0.8%) 28(13.8%) The ROC curve analysis results of four inflammatory markers are shown in Fig. 1 . The ROC curve analysis results show that WBCC, NE%, CRP, and NLR have good predictive effects on intestinal necrosis (AUC = 0.659,0.708,0.761,0.790). The ROC curve analysis results of inflammatory markers are shown in Table 4 . The cutoff value of WBCC is 7.3 * 10 9 /L, with a sensitivity of 82.1% and a specificity of 47.2% (AUC = 0.659; 95% CI, 0.580–0.737; p < 0.001). The cutoff value of NE% is 75.3%, the sensitivity is 91.0%, and the specificity is 47.2% (AUC = 0.708; 95% CI, 0.638–0.778; p < 0.001). The cutoff value of NLR is 8.2, with a sensitivity of 69.2% and a specificity of 75.2% (AUC = 0.761; 95% CI, 0.696–0.826; p < 0.001). The cutoff value of CRP is 10.0 mg/L, with a sensitivity of 67.9% and a specificity of 88.0% (AUC = 0.790; 95% CI, 0.720–0.859; p < 0.001). Table 4 ROC curve results of inflammatory markers Values WBCC NE% NLR CRP Cutoff 7.3 * 10 9 /L 75.3% 8.2 10.0 mg/L P value < 0.001 < 0.001 < 0.001 < 0.001 AUC (95% CI) 0.659 (0.580–0.737) 0.708 (0.638–0.778) 0.761 (0.696–0.826) 0.790 (0.720–0.859) AUC: area under curve, CI: confidence interval Discussion Inguinal hernia is a common clinical disease, and conservative treatment may be considered for children under 2 years old. Once diagnosed with inguinal hernia in adult patients, elective surgical treatment should be considered.[ 20 ] When the contents of the abdominal cavity enter the hernia sac and cannot be returned on their own, emergency treatment is required. Clinical doctors can choose between manual reduction, open surgery, or laparoscopic surgery for treatment.[ 20 – 22 ] We diagnose the severity of incarcerated inguinal hernia through inflammatory markers to assist clinical doctors in making decisions. A meta-analysis report suggests that gender is a high-risk factor for resection of incarcerated inguinal hernia.[ 5 ] And previous research reports also support gender as a high-risk factor for intestinal resection.[ 18 , 23 ] However, it was found in this study that gender is not a high risk factor for resection of incarcerated inguinal hernia. Previous literature reports have also reached similar conclusions as this study.[ 4 , 6 , 14 ] This study found that the type of hernia is a risk factor for intestinal resection of incarcerated inguinal hernia. This supports some previous literature reports.[ 5 , 6 , 18 , 23 ] The research reports of Turan et al. and Xie et al. refute this conclusion.[ 4 , 14 ] It is worth mentioning that the research report by Xie et al. only reported 95 cases.[ 14 ] Turan, U et al. reported 132 cases, of which only 19 were female.[ 4 ] This may have caused some bias in their analysis. At the same time, we found that the incidence rate of direct hernia in incarcerated inguinal hernia is very low. Similar situations have also existed in previous literature.[ 6 , 14 , 18 ] Interestingly, we found that in Chen, Peng et al.'s study, there were 167 male cases (167/323, 51.7%) in the non-intestinal resection group and 168 cases (168/323, 52.0%) in the non-intestinal resection group with indirect hernia.[ 18 ] In Eyvaz et al.'s study, there were 75 male cases (75/129, 58.3%) in the non-intestinal resection group and 78 cases (78/129, 60.6%) in the non-intestinal resection group with indirect hernia.[ 23 ] This is significantly higher than the results in this study, where there were 75 male cases (75/203, 36.9%) in the non-intestinal resection group and 70 cases (70/203, 34.5%) in the non-intestinal resection group with indirect hernia. Considering that we have come to the opposite conclusion regarding whether gender is a high-risk factor. We have conducted further thinking. A femoral hernia is located in the area of the femoral canal below the inguinal ligament, and is a hernia formed when abdominal contents protrude into the femoral canal through the femoral ring. The space of the femoral tube is narrow, and the author found in clinical work that incarcerated femoral hernia is more difficult to manually reduce compared to incarcerated inguinal hernia. The research report by Zhou et al. pointed out that the proportion of incarcerated femoral hernias in female is higher than that in male.[ 19 ] We speculate that the reason for this difference is that we performed manual reduction on patients with incarcerated inguinal hernia. Manual reduction is an effective treatment measure, suitable for patients who have the intention of elective surgery or have poor general conditions. Of course, in our institution, we are cautious when performing manual reduction procedures on patients. Once the manual reduction fails, we will immediately prepare emergency surgery for the patient. The age of the intestinal resection group was significantly higher than that of the non-intestinal resection group, which showed statistical differences. This indicates that advanced age is a high-risk factor affecting intestinal resection. Previous literature reports also support this viewpoint.[ 3 , 5 ] We speculate that this may be related to the delayed diagnosis and treatment of elderly patients, and perhaps strengthening education can improve this situation. At the same time, this study found that the duration of incarceration of the intestinal resection group was significantly higher than that of the non-intestinal resection group, which had statistical differences. This indicates that duration of incarceration is also a high-risk factor for intestinal resection, which supports the conclusions of previous studies.[ 5 , 24 – 26 ] This should be considered as the prolonged duration of incarceration will exacerbate intestinal ischemia and hypoxia, leading to intestinal necrosis. It is interesting that both the intestinal resection group and the non-intestinal resection group have a very large time span of entrapment. This indicates that we cannot determine whether a patient has developed intestinal necrosis based on a single time. The entrapment time of incarcerated inguinal hernia is not an absolute contraindication for manual reduction. We speculate that this may be due to some patients being unable to accurately express the time of occurrence of impaction. Or the degree of compression of the hernia contents by the hernia ring may vary. This study found that hyponatremia is also a high-risk factor for incarcerated inguinal hernia resection surgery. This is similar to the results of Keeley, JA et al.[ 27 ] We speculate that this may be related to intestinal obstruction caused by incarcerated inguinal hernia, leading to vomiting and hyponatremia. Therefore, we need to accelerate the treatment of incarcerated inguinal hernia patients with hyponatremia. We divided them into two groups based on the time from admission to surgery, and found no statistical difference between the two groups. This seems to indicate that a short-term extension after admission will not worsen the severity of incarcerated inguinal hernia. The research results of Knewitz et al. are similar to this.[ 28 ] Of course, we still believe that the faster the treatment of incarcerated inguinal hernia, the better, especially for patients with short incarcerated time. In this study, the cutoff value of NLR was 8.2. The research report by Chen et al. indicates that the NLR cutoff value is 6.5.[ 18 ] Zhou et al. also believe that the cutoff value is 6.5.[ 6 ] The cutoff value of Xie et al.'s report is 11.5.[ 14 ] Turan et al.'s study showed that the cutoff value of NLR is 6.66.[ 4 ] This means that the current reference values for NLR are controversial. Therefore, based on the ROC curve, this study selected a cutoff value of 8.2 for NLR. Meanwhile, WBCC, NE%, and CRP are common inflammatory markers, and we use the indicators from the blood analyzer as our reference values. In categorical variable analysis, we found that the proportion of increased inflammatory marker values in the intestinal resection group was significantly higher than that in the non-intestinal resection group. And they have statistical differences. In this study, the inflammatory marker values in the intestinal resection group were significantly higher than those in the non-intestinal resection group. There is a statistical difference between the two groups. This means that an increase in WBCC, NE%, CRP, and NLR values is a high-risk factor for intestinal resection of incarcerated inguinal hernia. And this confirms some previous literature reports.[ 4 – 6 , 14 , 18 , 23 ] This study investigated the value of combining inflammatory markers in the diagnosis of intestinal necrosis in incarcerated inguinal hernia. When WBCC, NE%, and CRP values all normal, there were 3 (3/48, 6.3%) patients in the intestinal resection group and 45 (45/48, 93.7%) patients in the non-intestinal resection group. When WBCC, NE%, and CRP values all increased, there were 30 (30/33, 90.9%) patients in the intestinal resection group and 3 (3/33, 9.1%) patients in the non-intestinal resection group. We also included NLR in the analysis. When WBCC, NE%, NLR, and CRP values all normal, there were 2 patients (2/47, 4.3%) in the intestinal resection group and 45 patients (45/47, 95.7%) in the non-intestinal resection group. When WBCC, NE%, NLR, and CRP values all increased, there were 27 patients (27/28, 96.4%) in the intestinal resection group and 1 patient (1/28, 3.6%) in the non-intestinal resection group. This indicates that the value of combining inflammatory markers in the diagnosis of incarcerated inguinal hernia and strangulated inguinal hernia is extremely high. However, this cannot fully predict intestinal necrosis in incarcerated inguinal hernia. This supports Xie et al.'s research that there are currently no biomarkers that can fully predict intestinal necrosis in incarcerated inguinal hernia.[ 14 ] The use of laparoscopic techniques to treat incarcerated inguinal hernia has been proven to be safe and feasible,[ 21 , 22 ] and early identification of intestinal necrosis in incarcerated inguinal hernia can help surgeons choose surgical methods. The AUC values of NLR and CRP were higher than those of WBCC and NE%, indicating that NLR and CRP have higher predictive value for intestinal resection of incarcerated inguinal hernia than WBCC and NE%. Xie et al.'s research report found that when NLR ≥ 11.5, the value of predicting strangulated inguinal hernia is higher compared to WBCC and neutrophil count.[ 14 ] Chen et al. stated that when NLR > 6.5, the value of predicting strangulated inguinal hernia is higher than WBCC and neutrophil count.[ 18 ] We look forward to more research to demonstrate their diagnostic value. When analyzing the data in this article, some limitations need to be considered. Firstly, as a single center retrospective study, our data is sourced from medical records and may have errors. Secondly, the amount of data in this study is not very large, which may bring some limitations to our analysis. In addition, CRP values less than or equal to 10.0mg/L in our center are considered 10.0mg/L, which may introduce bias to our analysis. Conclusions Elevated WBCC, NE%, NLR, or CRP values are high-risk factors for intestinal resection of incarcerated inguinal hernia. The combination of inflammatory markers is highly effective in predicting the severity of incarcerated inguinal hernia. The severity of incarcerated inguinal hernia is related to the duration of symptoms, but short-term delay after admission does not seem to exacerbate the severity of incarcerated inguinal hernia. NLR and CRP predict strangulated inguinal hernia better than WBCC and NE%. Abbreviations WBCC preoperative white blood cell count NE% percentage of neutrophils CRP C-reactive protein NLR neutrophil/lymphocyte ratio AUC the area under the curve CI confidence interval. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Liangping District People's Hospital in Chongqing. All patients in this study were informed, but as a retrospective study, written informed consent was waived. Consent for publication Written informed consent for publication was obtained from all participants. Funding This study did not receive any funding. Author Contribution JL, XT concept and design research, XT, CT collect data, JL analyze data, JL, XT writing a paper. All authors read and approved the final manuscript. Availability of data and materials According to reasonable requirements, the corresponding author can provide the current research dataset. Competing interests The authors declare that they have no conflict of interest. References Gianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G. Hernia repair in elderly patients. Br J Surg. 1997;84(7):983–5. Chen P, Huang L, Yang W, He D, Liu X, Wang Y, Yu Y, Yang L, Zhou Z. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. AM J EMERG MED. 2020;38(2):376–83. Bouassida M, Dougaz MW, Beji H, Guermazi H, Zribi S, Kammoun N, Bouasker I, Mongi Mighri M, Nouira R, Touinsi H. Intestinal ischemia in patients with incarcerated groin hernia: proposal and validation of a score. Langenbeck's Archives Surg. 2022;407(6):2547–54. Turan U, Baris-Dirim A. Predictivity of aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio for detecting bowel necrosis in incarcerated inguinal hernia patients. CIR CIR. 2023;91(4):494–500. Chen P, Huang L, Yang W, He D, Liu X, Wang Y, Yu Y, Yang L, Zhou Z. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. Am J Emerg Med. 2020;38(2):376–83. Zhou H, Ruan X, Shao X, Huang X, Fang G, Zheng X. Clinical value of the neutrophil/lymphocyte ratio in diagnosing adult strangulated inguinal hernia. INT J SURG. 2016;36(Pt A):76–80. Tanaka N, Uchida N, Ogihara H, Sasamoto H, Kato H, Kuwano H. Clinical study of inguinal and femoral incarcerated hernias. SURG TODAY. 2010;40(12):1144–7. Koizumi M, Sata N, Kaneda Y, Endo K, Sasanuma H, Sakuma Y, Ota M, Lefor AT, Yasuda Y. Optimal timeline for emergency surgery in patients with strangulated groin hernias. HERNIA 2014, 18(6):845–848. Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. WORLD J SURG. 2003;27(6):741–3. Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia. 2010;14(3):259–64. Zhou J, Yuan X. Establishment of a risk prediction model for bowel necrosis in patients with incarcerated inguinal hernia. BMC Med Inf Decis Mak. 2024;24(1):39. Eyvaz K. Neutrophil to C-reactive Protein Ratio (NCR); An Estimating Factor for Intestinal Ischemia Prior to the Surgery of Incarcerated Inguinal Hernia. İstanbul Kuzey Klinikleri. 2021;8(6):575–80. Chen L, Chen L, Wang YY, Zhang LX, Xia XG. A predictive model of bowel resection for incarcerated inguinal hernia based on the systemic immune-inflammation index. Front Surg. 2022;9(10):990481. Xie X, Feng S, Tang Z, Chen L, Huang Y, Yang X. Neutrophil-to-Lymphocyte Ratio Predicts the Severity of Incarcerated Groin Hernia. MED SCI MONITOR 2017, 23(2017):5558–5563. Al-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. AM J SURG. 2015;209(6):1043–7. Schellekens DH, Hulsewe KW, van Acker BA, van Bijnen AA, de Jaegere TM, Sastrowijoto SH, Buurman WA, Derikx JP. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. ACAD EMERG MED. 2013;20(7):703–10. Lavoignet CE, Le Borgne P, Chabrier S, Bidoire J, Slimani H, Chevrolet-Lavoignet J, Lefebvre F, Jebri R, Sengler L, Bilbault P. White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED. Eur J Clin Microbiol Infect Dis. 2019;38(8):1523–32. Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, Yang L, Zhou Z. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine. 2020;99(23):e20629. Zhou Z, Li Y, Li B, Yan L, Lei Y, Tong C. Construction and validation of a predictive model for the risk of bowel resection in adults with incarcerated groin hernia. BMC SURG. 2023;23(1):375. Association HAAW, Association EWGO. [Guidelines for diagnosis and treatment of inguinal hernia (2025 edition)]. Zhonghua Wei Chang Wai Ke Za Zhi. 2025;28(3):246–53. Poelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR, Campanelli G, van Dam D, Dwars BJ, Eker HH et al. EAES Consensus Development Conference on endoscopic repair of groin hernias. SURG ENDOSC 2013, 27(10):3505–3519. Liu J, Shen Y, Nie Y, Zhao X, Wang F, Chen J. If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia? WORLD J EMERG SURG. 2021;16(1):5. Eyvaz K, Dincer OI, Kazim KM, Dincer A, Aslaner A, Acar A, Cakir T. Neutrophil to C-reactive protein ratio: An estimating factor for intestinal ischemia before the surgery of incarcerated inguinal hernia. North Clin Istanb. 2021;8(6):575–80. Alhambra-Rodriguez DGC, Picazo-Yeste J, Tenias-Burillo JM, Moreno-Sanz C. Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. AM J SURG. 2013;205(2):188–93. Atila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg. 2010;395(5):563–8. Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. WORLD J SURG. 2003;27(6):741–3. Keeley JA, Kaji A, Kim DY, Putnam B, Neville A. Predictors of ischemic bowel in patients with incarcerated hernias. Hernia. 2019;23(2):277–80. Knewitz DK, Kirkpatrick SL, Jenkins PD, Al-Mansour M, Rosenthal MD, Efron PA, Loftus TJ. Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia. SURGERY. 2022;172(1):193–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 11 Nov, 2025 Reviews received at journal 10 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviews received at journal 04 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers invited by journal 01 Oct, 2025 Editor assigned by journal 26 Sep, 2025 Submission checks completed at journal 26 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7658202","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":529075846,"identity":"a2f7b71c-51f4-48a7-bfd3-ce510173fa1b","order_by":0,"name":"Xigui Tian","email":"","orcid":"","institution":"Liangping District People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xigui","middleName":"","lastName":"Tian","suffix":""},{"id":529075849,"identity":"520a6aa4-457c-4b1e-9e32-9503d6c39522","order_by":1,"name":"Caihao Tang","email":"","orcid":"","institution":"Liangping District People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Caihao","middleName":"","lastName":"Tang","suffix":""},{"id":529075850,"identity":"3a46fb14-c0b2-4ef1-ad64-80db6fe8e138","order_by":2,"name":"Jiaming Lan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACNvkDCQc+/rHhYWNvPkCcFj4JhocHZzakyfHzHEsgToucBOPjw5wNh4wlZ+QYEOkw6eaEw4w7DiRuOHPm4403DHZyug2EtMgcSzhceOZO4objvZst5zAkG5sdIKSFISfh8Ay2Z0Bbzm6T5mE4kLiNsJb8D4d52A4nbriR84xILRIJCYd52w6DvM9GpBaeAwkHZ5wBB7Kx5RwDIvwi396Q/OFDBTgqH954U2EnR1ALCpDgITJqkLWQqmMUjIJRMApGBAAAFhRMdYawdhQAAAAASUVORK5CYII=","orcid":"","institution":"Liangping District People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jiaming","middleName":"","lastName":"Lan","suffix":""}],"badges":[],"createdAt":"2025-09-19 11:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7658202/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7658202/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-026-03498-8","type":"published","date":"2026-01-17T16:30:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93638892,"identity":"5e0e6748-cbae-45b2-a30d-27cbace0caeb","added_by":"auto","created_at":"2025-10-16 02:01:57","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":500736,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.doc","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/d6c517176768660f9f44870a.doc"},{"id":93637653,"identity":"05b9dafc-6ca4-4c2c-9868-f2239f67cbdf","added_by":"auto","created_at":"2025-10-16 01:53:57","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4574,"visible":true,"origin":"","legend":"","description":"","filename":"0168ba2baf064d74a9971917e757c1e6.json","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/afb9954ddb7ddc967e9c63a3.json"},{"id":93638890,"identity":"44b194e9-fadb-4f41-8470-3f321be34672","added_by":"auto","created_at":"2025-10-16 02:01:57","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105221,"visible":true,"origin":"","legend":"","description":"","filename":"0168ba2baf064d74a9971917e757c1e61enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/d03aefeef3b61c198966b6cc.xml"},{"id":93637664,"identity":"a681d47e-8063-42c7-87f9-7c281a835e9a","added_by":"auto","created_at":"2025-10-16 01:53:58","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138637,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/06e50e79c5295b60fcde522c.jpeg"},{"id":93637655,"identity":"00f62b66-5679-4e74-a346-281ac447794f","added_by":"auto","created_at":"2025-10-16 01:53:57","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135480,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/756a1d6e5006b384a67185fb.jpeg"},{"id":93637652,"identity":"2eb80669-1788-4d59-a855-b597059557d1","added_by":"auto","created_at":"2025-10-16 01:53:57","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":133064,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/624937a58b99f011bd1de900.jpeg"},{"id":93637663,"identity":"d61bf836-f530-4511-a4d4-f7950aefcc8d","added_by":"auto","created_at":"2025-10-16 01:53:58","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136170,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/07832eda8cf1149c02af37d6.jpeg"},{"id":93637666,"identity":"0663c13d-819a-4c06-abd0-921089e8e66b","added_by":"auto","created_at":"2025-10-16 01:53:58","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44643,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/dc289931a06f884d9a3f05e2.png"},{"id":93637659,"identity":"1dee5a77-5d0f-4897-812c-6001ad4abc81","added_by":"auto","created_at":"2025-10-16 01:53:57","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45223,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/9913b032eb18521a59b5b6fe.png"},{"id":93638891,"identity":"7f1ad285-a7d3-4c00-887f-03b60e59f265","added_by":"auto","created_at":"2025-10-16 02:01:57","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41291,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/b8f97e921478eea90d42a40f.png"},{"id":93639639,"identity":"d1e4d339-9e44-4e49-8abe-589585de0cac","added_by":"auto","created_at":"2025-10-16 02:09:58","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44849,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/299acdf78bf4e9bbb31641e2.png"},{"id":93639640,"identity":"e5744f01-16ec-49e8-8d12-7db5c312f53b","added_by":"auto","created_at":"2025-10-16 02:09:58","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103515,"visible":true,"origin":"","legend":"","description":"","filename":"0168ba2baf064d74a9971917e757c1e61structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/41c52340f758026d4f14d7fd.xml"},{"id":93637660,"identity":"31b23cdb-ed41-4d93-8b41-55df1e87ebd2","added_by":"auto","created_at":"2025-10-16 01:53:58","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108770,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/26a15594991cca8d8f6efdcd.html"},{"id":93638894,"identity":"e8a03c69-1e53-4f56-9628-a7f25230b31a","added_by":"auto","created_at":"2025-10-16 02:01:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":179421,"visible":true,"origin":"","legend":"\u003cp\u003eROC analysis for preoperative white blood cell count (WBCC), percentage of neutrophils (NE%), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/f1447adaf9bfaf6fafdf9ff9.png"},{"id":100616127,"identity":"3fde817d-c1e0-4d17-a13d-c28e31ec7c97","added_by":"auto","created_at":"2026-01-19 17:40:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":856492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7658202/v1/da523bd7-567f-4b02-a504-0baf12bf2189.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Inflammatory markers are closely related to the diagnosis and prediction of severity of adult incarcerated inguinal hernia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInguinal hernia is a common surgical disease, and for adult patients, surgical treatment is the most effective treatment method.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] As the most common elective surgery worldwide, over 20\u0026nbsp;million people undergo inguinal hernia surgery every year for treatment.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] However, when the abdominal organs enter the hernia sac and cannot self-reduce due to the narrowing of the outer ring, they remain inside the hernia sac, leading to disturbance of blood circulation, which is called incarcerated inguinal hernia. This is a disease that requires emergency surgery, with approximately 5\u0026ndash;15% of patients with inguinal hernia experiencing incarceration. [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eIncarcerated inguinal hernia is a common cause of intestinal obstruction.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] If the incarcerated inguinal hernia can be relieved in time, the affected intestinal tract can return to normal, and intestinal obstruction can be cured. If the incarceration cannot be relieved in a timely manner, the increasing pressure on the intestinal tract and mesentery can reduce arterial blood flow, ultimately leading to complete blockage and the formation of strangulated inguinal hernia. At this point, the pulsation of the mesenteric artery disappears, and the intestinal wall gradually loses its luster, elasticity, and peristaltic ability, ultimately leading to intestinal necrosis. The hospitalization time of patients with intestinal necrosis will be significantly increased, and postoperative complications will be higher, about 6% -43%,[\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] with a mortality rate of 1% -7%.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eWhen the intestinal blood supply of incarcerated inguinal hernia is good, manual reduction is an acceptable treatment option, especially for patients with high anesthesia risk.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Exploratory laparotomy and laparoscopic exploration are common surgical methods for incarcerated inguinal hernia. If preoperative judgment requires intestinal resection, it will affect the choice of surgical method by the surgeon.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Therefore, preoperative assessment of whether intestinal ischemic necrosis has occurred in incarcerated inguinal hernia is helpful for clinical doctors in diagnosis and treatment selection. For example, advanced age, female gender, and type of inguinal hernia are common high-risk factors for intestinal resection of incarcerated inguinal hernia.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Inflammatory markers are used to diagnose and assess the severity of acute appendicitis.[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] This retrospective study aims to predict the severity of incarcerated inguinal hernia by analyzing different inflammatory markers.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003ePatients and data collection\u003c/p\u003e\u003cp\u003ePatients diagnosed with incarcerated inguinal hernia and undergoing surgical treatment in our hospital will be selected. We retrieved hospitalized patients related to the period from January 1, 2018 to December 31, 2024. This study has obtained the approval of the Ethics Committee of Liangping District People's Hospital in Chongqing.\u003c/p\u003e\u003cp\u003eAll patients diagnosed with incarcerated inguinal hernia will be selected by us, and we will confirm the diagnosis based on surgical records. We will select those who meet the following criteria: age\u0026thinsp;\u0026gt;\u0026thinsp;18 years, be treated surgically, not receiving antibiotic treatment before admission. The following situations will be ruled out by us: successful manual repositioning and scheduled surgery, the contents of the incarcerated hernia are the omentum, not receiving surgical treatment within 12 hours of admission, incarcerated inguinal hernia that occurred during hospitalization, have blood system diseases and other infectious diseases. All data comes from the patient's medical records, and we collected the following data: age, gender, month of onset, the time interval between symptom onset and hospitalization, the time interval between hospitalization and surgery, preoperative white blood cell count (WBCC), percentage of neutrophils (NE%), C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), serum Na\u003csup\u003e+\u003c/sup\u003e, type of hernia, hernia side, incarcerated organ, recurrent hernia, bowel resection.\u003c/p\u003e\u003cp\u003eAt our institution, patients will have their blood samples drawn upon admission. And sudden irreversible mass in the inguinal region accompanied by pain is defined as the time of symptom onset. We will designate March 21st to September 22nd as spring and summer, and September 23rd to March 20th of the following year as autumn and winter. When the patient is diagnosed with incarcerated inguinal hernia and there are no signs of peritonitis, we will perform manual reduction with the patient's informed consent. If the manual reset fails, we will perform emergency surgery on the patient.\u003c/p\u003e\u003cp\u003eBlood samples are measured by an automated hematology analyzer (Sysmex NX-10) and a fully automated electrolyte analyzer (LABOSPECT 008). In our institution, we consider WBCC, NE%, and CRP as common inflammatory markers, with abnormal reference upper limits of 9.5*10\u003csup\u003e9\u003c/sup\u003e/L, 75.0%, and 10.0mg/L, respectively. We found that NLR, as an inflammatory marker, is also used for the diagnosis of incarcerated inguinal hernia.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] The reference lower limit of serum Na\u003csup\u003e+\u003c/sup\u003e is 137.0 mmol/L. We decided whether to perform intestinal resection based on intraoperative exploration of intestinal ischemia, and divided the patients into two groups: bowel resection group and no bowel resection group. We explore sensitive indicators of intestinal necrosis by analyzing and comparing data from two groups of patients.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe used SPSS 24.0 (IBM, Armonk, NY, USA) software to analyze all the research data. Categorical variables are analyzed using percentages for descriptive statistics, and Chi-square test or Fisher's exact tests are used for analysis depending on the situation. Continuous variables with normal distribution are represented by mean \u0026plusmn; (standard deviation), maximum and minimum values, and then independent sample t-test is used to detect whether there is a difference between the two groups.\u003c/p\u003e\u003cp\u003eWe use ROC curve to determine the optimal critical value of inflammatory markers for intestinal necrosis. The maximum value of the Youden index corresponds to the optimal diagnostic threshold, which is the cutoff value. We will calculate the area under the curve (AUC), ROC curve, and 95% confidence interval (CI) of AUC. In our analysis process, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 will be considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAccording to the inclusion and exclusion criteria, a total of 203 patients were selected for this study. Among them, there were more male patients than female patients, with 117 male patients (57.6%) and 86 female patients (42.4%). Some factors (categorical variables) that may affect intestinal resection for incarcerated inguinal hernia are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were 78 patients in the intestinal resection group, including 42 male patients (53.8%) and 36 female patients 36(46.2%). There were 125 patients in the non-intestinal resection group, including 75 male patients (60.0%) and 50 female patients (40.0%). There is no statistical difference between these two groups (p\u0026thinsp;=\u0026thinsp;0.388). There was no statistical difference between the two groups in terms of the season of onset, previous occurrence of inguinal hernia, hernia side, incarcerated organ, and time from admission to surgery (p\u0026thinsp;=\u0026thinsp;0.798, p\u0026thinsp;=\u0026thinsp;0.748, p\u0026thinsp;=\u0026thinsp;0.122, p\u0026thinsp;=\u0026thinsp;0.078, p\u0026thinsp;=\u0026thinsp;0.260). Type of hernia, WBCC, NE%, CRP, NLR, and serum Na\u0026thinsp;+\u0026thinsp;showed statistical differences between the two groups(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the intestinal resection group, there were 56 cases of femoral hernia patients, accounting for a relatively high proportion of 71.8%. In the non-intestinal resection group, there were 70 cases of indirect hernia patients, accounting for a relatively high proportion of 56.0%.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (categorical variables)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;78\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo bowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;203\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42(53.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75(60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117(57.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(46.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86(42.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmission season\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpring and summer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(46.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60(48.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e96(47.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutumn and winter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42(53.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65(52.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e107(52.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndirect hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70(56.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e92(45.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemoral hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56(71.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e106(52.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5(2.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrent hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9(4.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75(96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e119(95.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e194(95.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHernia side\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(34.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57(45.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e84(41.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51(65.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68(54.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e119(58.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncarcerated organ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall bowel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76(97.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114(91.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e190(93.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11(8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13(6.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBCC (10\u003csup\u003e9\u003c/sup\u003e /L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88(70.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e127(62.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37(29.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e76(37.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNE%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(9.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(47.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e66(32.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71(91.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66(52.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e137(67.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP (mg/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25(32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110(88.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e135(66.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53(67.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(12.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e68(33.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24(30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94(75.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e118(58.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54(69.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31(24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85(41.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNa\u003csup\u003e+\u003c/sup\u003e (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;137.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18(23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23(11.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;137.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60(76.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e120(96.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e180(88.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn-hospital time (h)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47(60.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85(68.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e132(65.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31(39.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40(32.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e71(35.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eWBCC: preoperative white blood cell count, NE%: percentage of neutrophils, CRP:C-reactive protein, NLR: neutrophil/lymphocyte ratio\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUnivariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (continuous variable) is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The average age of the intestinal resection group was 72.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33 years, while the average age of the non-intestinal resection group was 68.08\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74 years. The age of the intestinal resection group is higher than that of the non-intestinal resection group, and there is a statistical difference between them(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were also statistical differences in duration of incarceration, WBCC, NE%, CRP, and NLR between the two groups(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The duration of incarceration, WBCC, NE%, CRP, and NLR values of the intestinal resection group were significantly higher than those of the non-intestinal resection group. Finally, we can observe that the range of maximum and minimum values in each group is quite large.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis of factors affecting intestinal resection for incarcerated inguinal hernia (continuous variable)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;78\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo bowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33(46,88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e68.08\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74(35,92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of incarceration (h, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e62.10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.50(3,288)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e33.12\u0026thinsp;\u0026plusmn;\u0026thinsp;48.49(2,240)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBCC (10\u003csup\u003e9\u003c/sup\u003e /L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33(2.41,15.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e8.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04(2.95,17.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNE% (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e83.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70(65.7,95.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e75.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37(54.1,93.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15(2.88,40.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83(1.58,32.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP (mg/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, (min, max))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e43.63\u0026thinsp;\u0026plusmn;\u0026thinsp;44.11(10,175.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54(10,96.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe sensitivity of inflammatory markers in the diagnosis of whether to perform intestinal resection based on surgical results is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The increase of individual inflammatory markers, such as WBCC, NE%, CRP, and NLR, has higher sensitivity in the intestinal resection group, but lower sensitivity in the non-intestinal resection group. And we analyzed the situation where several inflammatory markers were either normal or elevated simultaneously. When several inflammatory markers are normal at the same time, it has extremely high sensitivity for diagnosing patients who have not undergone intestinal resection surgery. When the values of several inflammatory markers increase simultaneously, it has extremely high sensitivity for diagnosing patients undergoing intestinal resection surgery. It is worth mentioning that even if inflammatory markers are normal or elevated at the same time, it cannot accurately predict whether intestinal resection surgery will be performed.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAccording to the surgical results, the sensitivity of inflammatory markers (WBCC, NE%, NLR, and CRP) to elevated or simultaneously elevated or simultaneously normal is determined\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;78\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo bowel resection\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;203\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated WBCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37(29.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76(37.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated NE%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71(91.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66(52.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e137(67.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated NLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54(69.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31(24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e85(41.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated CRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53(67.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(12.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68(33.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal WBCC, NE%, CRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45(36.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48(23.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal WBCC, NE%, NLR, CRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45(36.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47(23.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated WBCC, NE%, CRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33(16.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElevated WBCC, NE%, NLR, CRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(34.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28(13.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe ROC curve analysis results of four inflammatory markers are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The ROC curve analysis results show that WBCC, NE%, CRP, and NLR have good predictive effects on intestinal necrosis (AUC\u0026thinsp;=\u0026thinsp;0.659,0.708,0.761,0.790).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe ROC curve analysis results of inflammatory markers are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The cutoff value of WBCC is 7.3 * 10\u003csup\u003e9\u003c/sup\u003e/L, with a sensitivity of 82.1% and a specificity of 47.2% (AUC\u0026thinsp;=\u0026thinsp;0.659; 95% CI, 0.580\u0026ndash;0.737; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The cutoff value of NE% is 75.3%, the sensitivity is 91.0%, and the specificity is 47.2% (AUC\u0026thinsp;=\u0026thinsp;0.708; 95% CI, 0.638\u0026ndash;0.778; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The cutoff value of NLR is 8.2, with a sensitivity of 69.2% and a specificity of 75.2% (AUC\u0026thinsp;=\u0026thinsp;0.761; 95% CI, 0.696\u0026ndash;0.826; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The cutoff value of CRP is 10.0 mg/L, with a sensitivity of 67.9% and a specificity of 88.0% (AUC\u0026thinsp;=\u0026thinsp;0.790; 95% CI, 0.720\u0026ndash;0.859; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eROC curve results of inflammatory markers\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eValues\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWBCC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNE%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNLR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCutoff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.3 * 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.0 mg/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAUC\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.659\u003c/p\u003e\u003cp\u003e(0.580\u0026ndash;0.737)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.708\u003c/p\u003e\u003cp\u003e(0.638\u0026ndash;0.778)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.761\u003c/p\u003e\u003cp\u003e(0.696\u0026ndash;0.826)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003cp\u003e(0.720\u0026ndash;0.859)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAUC: area under curve, CI: confidence interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInguinal hernia is a common clinical disease, and conservative treatment may be considered for children under 2 years old. Once diagnosed with inguinal hernia in adult patients, elective surgical treatment should be considered.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] When the contents of the abdominal cavity enter the hernia sac and cannot be returned on their own, emergency treatment is required. Clinical doctors can choose between manual reduction, open surgery, or laparoscopic surgery for treatment.[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] We diagnose the severity of incarcerated inguinal hernia through inflammatory markers to assist clinical doctors in making decisions.\u003c/p\u003e\u003cp\u003eA meta-analysis report suggests that gender is a high-risk factor for resection of incarcerated inguinal hernia.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] And previous research reports also support gender as a high-risk factor for intestinal resection.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] However, it was found in this study that gender is not a high risk factor for resection of incarcerated inguinal hernia. Previous literature reports have also reached similar conclusions as this study.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThis study found that the type of hernia is a risk factor for intestinal resection of incarcerated inguinal hernia. This supports some previous literature reports.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] The research reports of Turan et al. and Xie et al. refute this conclusion.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] It is worth mentioning that the research report by Xie et al. only reported 95 cases.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Turan, U et al. reported 132 cases, of which only 19 were female.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] This may have caused some bias in their analysis. At the same time, we found that the incidence rate of direct hernia in incarcerated inguinal hernia is very low. Similar situations have also existed in previous literature.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Interestingly, we found that in Chen, Peng et al.'s study, there were 167 male cases (167/323, 51.7%) in the non-intestinal resection group and 168 cases (168/323, 52.0%) in the non-intestinal resection group with indirect hernia.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] In Eyvaz et al.'s study, there were 75 male cases (75/129, 58.3%) in the non-intestinal resection group and 78 cases (78/129, 60.6%) in the non-intestinal resection group with indirect hernia.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] This is significantly higher than the results in this study, where there were 75 male cases (75/203, 36.9%) in the non-intestinal resection group and 70 cases (70/203, 34.5%) in the non-intestinal resection group with indirect hernia. Considering that we have come to the opposite conclusion regarding whether gender is a high-risk factor. We have conducted further thinking. A femoral hernia is located in the area of the femoral canal below the inguinal ligament, and is a hernia formed when abdominal contents protrude into the femoral canal through the femoral ring. The space of the femoral tube is narrow, and the author found in clinical work that incarcerated femoral hernia is more difficult to manually reduce compared to incarcerated inguinal hernia. The research report by Zhou et al. pointed out that the proportion of incarcerated femoral hernias in female is higher than that in male.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] We speculate that the reason for this difference is that we performed manual reduction on patients with incarcerated inguinal hernia. Manual reduction is an effective treatment measure, suitable for patients who have the intention of elective surgery or have poor general conditions. Of course, in our institution, we are cautious when performing manual reduction procedures on patients. Once the manual reduction fails, we will immediately prepare emergency surgery for the patient.\u003c/p\u003e\u003cp\u003eThe age of the intestinal resection group was significantly higher than that of the non-intestinal resection group, which showed statistical differences. This indicates that advanced age is a high-risk factor affecting intestinal resection. Previous literature reports also support this viewpoint.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] We speculate that this may be related to the delayed diagnosis and treatment of elderly patients, and perhaps strengthening education can improve this situation. At the same time, this study found that the duration of incarceration of the intestinal resection group was significantly higher than that of the non-intestinal resection group, which had statistical differences. This indicates that duration of incarceration is also a high-risk factor for intestinal resection, which supports the conclusions of previous studies.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] This should be considered as the prolonged duration of incarceration will exacerbate intestinal ischemia and hypoxia, leading to intestinal necrosis. It is interesting that both the intestinal resection group and the non-intestinal resection group have a very large time span of entrapment. This indicates that we cannot determine whether a patient has developed intestinal necrosis based on a single time. The entrapment time of incarcerated inguinal hernia is not an absolute contraindication for manual reduction. We speculate that this may be due to some patients being unable to accurately express the time of occurrence of impaction. Or the degree of compression of the hernia contents by the hernia ring may vary.\u003c/p\u003e\u003cp\u003eThis study found that hyponatremia is also a high-risk factor for incarcerated inguinal hernia resection surgery. This is similar to the results of Keeley, JA et al.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] We speculate that this may be related to intestinal obstruction caused by incarcerated inguinal hernia, leading to vomiting and hyponatremia. Therefore, we need to accelerate the treatment of incarcerated inguinal hernia patients with hyponatremia.\u003c/p\u003e\u003cp\u003eWe divided them into two groups based on the time from admission to surgery, and found no statistical difference between the two groups. This seems to indicate that a short-term extension after admission will not worsen the severity of incarcerated inguinal hernia. The research results of Knewitz et al. are similar to this.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] Of course, we still believe that the faster the treatment of incarcerated inguinal hernia, the better, especially for patients with short incarcerated time.\u003c/p\u003e\u003cp\u003eIn this study, the cutoff value of NLR was 8.2. The research report by Chen et al. indicates that the NLR cutoff value is 6.5.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Zhou et al. also believe that the cutoff value is 6.5.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The cutoff value of Xie et al.'s report is 11.5.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Turan et al.'s study showed that the cutoff value of NLR is 6.66.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] This means that the current reference values for NLR are controversial. Therefore, based on the ROC curve, this study selected a cutoff value of 8.2 for NLR. Meanwhile, WBCC, NE%, and CRP are common inflammatory markers, and we use the indicators from the blood analyzer as our reference values. In categorical variable analysis, we found that the proportion of increased inflammatory marker values in the intestinal resection group was significantly higher than that in the non-intestinal resection group. And they have statistical differences. In this study, the inflammatory marker values in the intestinal resection group were significantly higher than those in the non-intestinal resection group. There is a statistical difference between the two groups. This means that an increase in WBCC, NE%, CRP, and NLR values is a high-risk factor for intestinal resection of incarcerated inguinal hernia. And this confirms some previous literature reports.[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThis study investigated the value of combining inflammatory markers in the diagnosis of intestinal necrosis in incarcerated inguinal hernia. When WBCC, NE%, and CRP values all normal, there were 3 (3/48, 6.3%) patients in the intestinal resection group and 45 (45/48, 93.7%) patients in the non-intestinal resection group. When WBCC, NE%, and CRP values all increased, there were 30 (30/33, 90.9%) patients in the intestinal resection group and 3 (3/33, 9.1%) patients in the non-intestinal resection group. We also included NLR in the analysis. When WBCC, NE%, NLR, and CRP values all normal, there were 2 patients (2/47, 4.3%) in the intestinal resection group and 45 patients (45/47, 95.7%) in the non-intestinal resection group. When WBCC, NE%, NLR, and CRP values all increased, there were 27 patients (27/28, 96.4%) in the intestinal resection group and 1 patient (1/28, 3.6%) in the non-intestinal resection group. This indicates that the value of combining inflammatory markers in the diagnosis of incarcerated inguinal hernia and strangulated inguinal hernia is extremely high. However, this cannot fully predict intestinal necrosis in incarcerated inguinal hernia. This supports Xie et al.'s research that there are currently no biomarkers that can fully predict intestinal necrosis in incarcerated inguinal hernia.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] The use of laparoscopic techniques to treat incarcerated inguinal hernia has been proven to be safe and feasible,[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and early identification of intestinal necrosis in incarcerated inguinal hernia can help surgeons choose surgical methods.\u003c/p\u003e\u003cp\u003eThe AUC values of NLR and CRP were higher than those of WBCC and NE%, indicating that NLR and CRP have higher predictive value for intestinal resection of incarcerated inguinal hernia than WBCC and NE%. Xie et al.'s research report found that when NLR\u0026thinsp;\u0026ge;\u0026thinsp;11.5, the value of predicting strangulated inguinal hernia is higher compared to WBCC and neutrophil count.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Chen et al. stated that when NLR\u0026thinsp;\u0026gt;\u0026thinsp;6.5, the value of predicting strangulated inguinal hernia is higher than WBCC and neutrophil count.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] We look forward to more research to demonstrate their diagnostic value.\u003c/p\u003e\u003cp\u003eWhen analyzing the data in this article, some limitations need to be considered. Firstly, as a single center retrospective study, our data is sourced from medical records and may have errors. Secondly, the amount of data in this study is not very large, which may bring some limitations to our analysis. In addition, CRP values less than or equal to 10.0mg/L in our center are considered 10.0mg/L, which may introduce bias to our analysis.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eElevated WBCC, NE%, NLR, or CRP values are high-risk factors for intestinal resection of incarcerated inguinal hernia. The combination of inflammatory markers is highly effective in predicting the severity of incarcerated inguinal hernia. The severity of incarcerated inguinal hernia is related to the duration of symptoms, but short-term delay after admission does not seem to exacerbate the severity of incarcerated inguinal hernia. NLR and CRP predict strangulated inguinal hernia better than WBCC and NE%.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWBCC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epreoperative white blood cell count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNE%\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epercentage of neutrophils\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC-reactive protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNLR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eneutrophil/lymphocyte ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ethe area under the curve\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econfidence interval.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was approved by the Ethics Committee of Liangping District People's Hospital in Chongqing. All patients in this study were informed, but as a retrospective study, written informed consent was waived.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e Written informed consent for publication was obtained from all participants.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJL, XT concept and design research, XT, CT collect data, JL analyze data, JL, XT writing a paper. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eAccording to reasonable requirements, the corresponding author can provide the current research dataset.\u003c/p\u003e\u003cp\u003eCompeting interests\u003c/p\u003e\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G. Hernia repair in elderly patients. Br J Surg. 1997;84(7):983\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen P, Huang L, Yang W, He D, Liu X, Wang Y, Yu Y, Yang L, Zhou Z. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. AM J EMERG MED. 2020;38(2):376\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBouassida M, Dougaz MW, Beji H, Guermazi H, Zribi S, Kammoun N, Bouasker I, Mongi Mighri M, Nouira R, Touinsi H. Intestinal ischemia in patients with incarcerated groin hernia: proposal and validation of a score. Langenbeck's Archives Surg. 2022;407(6):2547\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTuran U, Baris-Dirim A. Predictivity of aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio for detecting bowel necrosis in incarcerated inguinal hernia patients. CIR CIR. 2023;91(4):494\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen P, Huang L, Yang W, He D, Liu X, Wang Y, Yu Y, Yang L, Zhou Z. Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis. Am J Emerg Med. 2020;38(2):376\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou H, Ruan X, Shao X, Huang X, Fang G, Zheng X. Clinical value of the neutrophil/lymphocyte ratio in diagnosing adult strangulated inguinal hernia. INT J SURG. 2016;36(Pt A):76\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTanaka N, Uchida N, Ogihara H, Sasamoto H, Kato H, Kuwano H. Clinical study of inguinal and femoral incarcerated hernias. SURG TODAY. 2010;40(12):1144\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoizumi M, Sata N, Kaneda Y, Endo K, Sasanuma H, Sakuma Y, Ota M, Lefor AT, Yasuda Y. Optimal timeline for emergency surgery in patients with strangulated groin hernias. \u003cem\u003eHERNIA\u003c/em\u003e 2014, 18(6):845\u0026ndash;848.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. WORLD J SURG. 2003;27(6):741\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGe BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia. 2010;14(3):259\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou J, Yuan X. Establishment of a risk prediction model for bowel necrosis in patients with incarcerated inguinal hernia. BMC Med Inf Decis Mak. 2024;24(1):39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEyvaz K. Neutrophil to C-reactive Protein Ratio (NCR); An Estimating Factor for Intestinal Ischemia Prior to the Surgery of Incarcerated Inguinal Hernia. İstanbul Kuzey Klinikleri. 2021;8(6):575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen L, Chen L, Wang YY, Zhang LX, Xia XG. A predictive model of bowel resection for incarcerated inguinal hernia based on the systemic immune-inflammation index. Front Surg. 2022;9(10):990481.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXie X, Feng S, Tang Z, Chen L, Huang Y, Yang X. Neutrophil-to-Lymphocyte Ratio Predicts the Severity of Incarcerated Groin Hernia. \u003cem\u003eMED SCI MONITOR\u003c/em\u003e 2017, 23(2017):5558\u0026ndash;5563.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. AM J SURG. 2015;209(6):1043\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchellekens DH, Hulsewe KW, van Acker BA, van Bijnen AA, de Jaegere TM, Sastrowijoto SH, Buurman WA, Derikx JP. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis in patients suspected for acute appendicitis. ACAD EMERG MED. 2013;20(7):703\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLavoignet CE, Le Borgne P, Chabrier S, Bidoire J, Slimani H, Chevrolet-Lavoignet J, Lefebvre F, Jebri R, Sengler L, Bilbault P. White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED. Eur J Clin Microbiol Infect Dis. 2019;38(8):1523\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, Yang L, Zhou Z. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine. 2020;99(23):e20629.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou Z, Li Y, Li B, Yan L, Lei Y, Tong C. Construction and validation of a predictive model for the risk of bowel resection in adults with incarcerated groin hernia. BMC SURG. 2023;23(1):375.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAssociation HAAW, Association EWGO. [Guidelines for diagnosis and treatment of inguinal hernia (2025 edition)]. Zhonghua Wei Chang Wai Ke Za Zhi. 2025;28(3):246\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR, Campanelli G, van Dam D, Dwars BJ, Eker HH et al. EAES Consensus Development Conference on endoscopic repair of groin hernias. \u003cem\u003eSURG ENDOSC\u003c/em\u003e 2013, 27(10):3505\u0026ndash;3519.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu J, Shen Y, Nie Y, Zhao X, Wang F, Chen J. If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia? WORLD J EMERG SURG. 2021;16(1):5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEyvaz K, Dincer OI, Kazim KM, Dincer A, Aslaner A, Acar A, Cakir T. Neutrophil to C-reactive protein ratio: An estimating factor for intestinal ischemia before the surgery of incarcerated inguinal hernia. North Clin Istanb. 2021;8(6):575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlhambra-Rodriguez DGC, Picazo-Yeste J, Tenias-Burillo JM, Moreno-Sanz C. Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. AM J SURG. 2013;205(2):188\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAtila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg. 2010;395(5):563\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. WORLD J SURG. 2003;27(6):741\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKeeley JA, Kaji A, Kim DY, Putnam B, Neville A. Predictors of ischemic bowel in patients with incarcerated hernias. Hernia. 2019;23(2):277\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKnewitz DK, Kirkpatrick SL, Jenkins PD, Al-Mansour M, Rosenthal MD, Efron PA, Loftus TJ. Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia. SURGERY. 2022;172(1):193\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"incarcerated groin hernia, bowel resection, inflammatory markers","lastPublishedDoi":"10.21203/rs.3.rs-7658202/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7658202/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIncarcerated inguinal hernia can further develop into strangulated inguinal hernia, and their diagnosis is challenging. This article aims to explore whether inflammatory markers in the blood are helpful in the diagnosis of incarcerated inguinal hernia and in predicting the severity of incarcerated inguinal hernia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe selected patients with incarcerated inguinal hernia who underwent surgical treatment between January 1, 2018 and December 31, 2024. All patients completed blood tests before surgery. All patients were divided into two groups, bowel resection group and no bowel resection group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 203 patients were included in the study, including 78 patients in the intestinal resection group. There were no statistically significant differences in sex, admission season, recurrent hernia, hernia side, incarcerated organ, and in-hospital time between the two groups. There are statistical differences in type of hernia, WBCC, NE%, NLR, CRP, and serum Na\u0026thinsp;+\u0026thinsp;between the two groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWBCC, NE%, NLR, and CRP values can be used to diagnose incarcerated inguinal hernia. Combining inflammatory markers to predict the severity of incarcerated inguinal hernia is highly effective.\u003c/p\u003e","manuscriptTitle":"Inflammatory markers are closely related to the diagnosis and prediction of severity of adult incarcerated inguinal hernia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 01:53:52","doi":"10.21203/rs.3.rs-7658202/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-11T08:22:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-10T12:05:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134630731108432632633024054762137131678","date":"2025-11-10T11:34:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302929669156960215381636274987844297187","date":"2025-11-09T17:18:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150977190088262358063553731581161293252","date":"2025-11-09T14:57:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T10:57:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306600671916479392659968842700257380815","date":"2025-11-05T22:35:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307852853957848078074896942485334104647","date":"2025-11-05T10:08:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314209536102970106352390995944455376877","date":"2025-11-04T19:45:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-04T18:06:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76239841408718295420399282074008758188","date":"2025-11-04T17:05:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81661064181797498125451661828113449295","date":"2025-11-04T17:01:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12440992637797365334767793623111495432","date":"2025-11-04T06:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-01T20:47:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-26T06:18:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T06:18:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-09-19T11:35:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2d29fb2c-d405-4e5e-a052-df3d0366ab50","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:06:38+00:00","versionOfRecord":{"articleIdentity":"rs-7658202","link":"https://doi.org/10.1186/s12893-026-03498-8","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2026-01-17 16:30:43","publishedOnDateReadable":"January 17th, 2026"},"versionCreatedAt":"2025-10-16 01:53:52","video":"","vorDoi":"10.1186/s12893-026-03498-8","vorDoiUrl":"https://doi.org/10.1186/s12893-026-03498-8","workflowStages":[]},"version":"v1","identity":"rs-7658202","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7658202","identity":"rs-7658202","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}