Lactate, mean platelet volume, and nSOFA as combined predictors of perforated necrotizing enterocolitis and mortality in preterm infants: a retrospective cohort study

Background Perforated necrotizing enterocolitis (PNEC) is a lethal complication in preterm infants with high mortality, but timely identification and prognostic stratification remain clinically challenging.Methods This retrospective cohort study analyzed 110 preterm infants with surgical NEC admitted between 2023–2025, stratified into non-intestinal perforation (NIP group, n = 55) and PNEC (n = 55) subgroups. Correlation, multivariate logistic regression, mediation, and receiver operating characteristic (ROC) curve analyses were performed.Results Compared with the NIP group, the PNEC group had significantly higher lactate (6.0 vs. 3.9 mmol/L), mean platelet volume (MPV, 12.20 vs. 10.79 fL), neonatal Sequential Organ Failure Assessment (nSOFA, 5.0 vs. 2.0), and mortality (27.3% vs. 10.9%) (all p < 0.05). Multivariate regression identified lactate (OR = 1.218) and MPV (OR = 1.725) as independent risk factors for PNEC. Mediation analysis showed lactate exerted 32.53% indirect effect on PNEC via MPV, and nSOFA mediated 23.95% of lactate’s effect on mortality. The combination of lactate + MPV + nSOFA outperformed single markers in predicting PNEC (AUC = 0.800) and mortality (AUC = 0.949).Conclusions The combination of lactate, MPV, and nSOFA exhibits synergistic predictive value for PNEC and its associated mortality. Lactate and MPV identify early perforation risk, while nSOFA stratifies mortality risk. This combination provides clinical utility for the early intervention of high-risk neonates with NEC.