CLINICAL-IMMUNOLOGICAL RATIONALE FOR TREATMENT OF ACUTE ADHESIVE SMALL BOWEL OBSTRUCTION: PROGNOSTIC SCALE AND EFFICACY OF IMMUNE CORRECTION

Acute adhesive small bowel obstruction (AASBO) ranks among the most common indications for emergency abdominal surgery. However, conventional approaches to severity assessment and treatment selection do not incorporate the significant immunological disturbances characteristic of this condition. Objective. To enhance the diagnosis and management of AASBO through the implementation of a clinical-immunological risk stratification scale and to evaluate the impact of immunotherapy on clinical and immune outcomes. Materials and Methods. A total of 115 patients with AASBO were enrolled and allocated to a control group (n=56; standard care) or a study group (n=59; standard care plus immunotherapy). Comprehensive clinical, laboratory, radiological, and immunological parameters were analyzed. A prognostic scale incorporating 25 variables was developed. Immune response dynamics and complication rates were rigorously assessed. All procedures were conducted in accordance with the World Medical Association's Declaration of Helsinki (2000 amendments). Statistical analyses were performed using SPSS 22.0 and MedCalc software. Normality was assessed with Shapiro-Wilk test. Between-group comparisons utilized Mann-Whitney U test, Student's t-test, Pearson's chi-square test, and Spearman's correlation analysis. Predictive performance was evaluated through ROC analysis calculating the area under the curve (AUC). Statistical significance was defined as p < 0.05. Funding: This work was carried out within the framework of the research plan of the Bukhara State Medical Institute (05.2022 DSc.135) entitled “Development of new approaches to early diagnosis, treatment, and prevention of pathological conditions affecting the health of the population of the Bukhara region after COVID-19 (2022–2026)”. Results. Severe disease progression was significantly associated with CD4⁺ counts < 600 cells/µL, HLA-DR⁺ expression < 30%, IL-6 levels > 30 pg/mL, and TNF-α levels > 25 pg/mL. The study group demonstrated a 3.3-fold reduction in mortality, a 28.1% shorter hospital stay, and a 2.4-fold decrease in Clavien-Dindo grade III-V complications. The integrated prognostic scale exhibited high predictive accuracy (AUC = 0.917). Conclusion. The incorporation of clinical-immunological stratification and immunotherapy into the management algorithm for AASBO significantly improves treatment outcomes, reduces complication rates, and decreases mortality.