Evaluation of the prognostic impact of laboratory parameters, imaging findings, and the big score in patients diagnosed with Ileus presenting to the emergency department

ABSTRACT Evaluation of the Prognostic Impact of Laboratory Parameters, Imaging Findings, and the BIG Score in Patients Diagnosed with Ileus Presenting to the Emergency Department Objective: The aim of this study was to evaluate the prognostic value of laboratory parameters, imaging findings, and in particular the BIG score in patients presenting to the emergency department with ileus, and to investigate their predictive power for mortality and surgical intervention, thereby contributing to clinical risk stratification. Materials and Methods: This retrospective, single-center, observational study was conducted at the Emergency Medicine Department of Süleyman Demirel University Medical Faculty Hospital. Medical records of adult patients admitted to the emergency department between October 1, 2021, and May 15, 2025, with a diagnosis of ileus (ICD-10: K56.7) were reviewed. Patients with complete medical records were included. Demographic data, admission vital signs, etiology of ileus, surgical requirement, mortality, length of stay, laboratory results (WBC, NE, LY, MO, HGB, PLT, MPV, glucose, BUN, creatinine, Na, K, Cl, Ca, albumin, PT, aPTT, INR, CRP, arterial blood gas parameters including pH, HCO3, pCO2, base deficit, and lactate), GCS and BIG scores, inflammatory indices (NLR, MLR, L/Alb, HALP, SII, SIRI, AISI), and imaging findings (bowel dilatation diameter on CT) were recorded. Results: The mean age of the patients was 63.17 ± 16.65 years. Length of hospital stay, bowel dilatation diameter, albumin, platelet, CRP, base deficit, MLR, AISI, HALP, and BIG scores were statistically significant between patients undergoing surgery and those treated conservatively. Mortality was significantly associated with age, GCS, length of stay, hemoglobin, albumin, CRP, base deficit, lactate, HALP, and BIG scores. ROC analysis demonstrated that the most predictive parameters for surgical intervention were BIG score (AUC: 0.668) and bowel dilatation diameter (AUC: 0.658), while the most predictive parameters for mortality were BIG score (AUC: 0.784) and CRP (AUC: 0.725). Logistic regression showed that each one-point increase in BIG score increased the likelihood of surgery by 1.100 times. Cox regression analysis revealed that each 1 g/dL decrease in albumin increased mortality risk by 2.45 times. Conclusion: This study demonstrated that laboratory parameters, imaging findings, and the BIG score provide important prognostic information in patients with ileus presenting to the emergency department. Several laboratory and imaging variables were found to be significant predictors of surgical intervention and mortality. Importantly, the BIG score was identified as a powerful discriminative factor for both surgical requirement and mortality, and was directly associated with survival. These findings suggest that the BIG score, previously studied primarily in trauma populations, may also have prognostic value in ileus patients. Our results highlight the potential of this parameter as a practical tool to guide clinical decision-making and to identify high-risk patients early, thereby contributing to optimized management strategies. Keywords: Ileus, Surgery, Mortality, BIG Score