International Journal of General Medicine (Oct 2023)

Risk Factors of Gastrointestinal Perforation with a Poor Prognosis

  • Yuan W,
  • Zhou X,
  • Cai Z,
  • Qiu J,
  • Li X,
  • Tong G

Journal volume & issue
Vol. Volume 16
pp. 4637 – 4647

Abstract

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Wenqing Yuan,1,* Xiaozhuan Zhou,2,* Zhigao Cai,1 Junyu Qiu,1 Xi Li,2 Gangling Tong1,3 1Department of Gastrointestinal Surgery, Longchuan County People’s Hospital, Heyuan, 517300, People’s Republic of China; 2Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, 518036, People’s Republic of China; 3Department of Oncology, Peking University Shenzhen Hospital, Shenzhen 518036, China and Shenzhen Key Laboratory of Gastrointestinal Cancer Translational Research, Cancer Institute of Shenzhen-PKU-HKUST Medical Center, Shenzhen, 518036, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xi Li, Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, 518036, People’s Republic of China, Tel/Fax +86-75583923333, Email [email protected] Gangling Tong, Department of Oncology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, 518036, People’s Republic of China, Tel +86-75583923333, Fax +86-75583061340, Email [email protected]: Despite medical progress, mortality from gastrointestinal perforation was relatively high. Our study’s objective was to identify risk factors associated with a poor prognosis for gastrointestinal perforation.Methods: Patients diagnosed with gastrointestinal perforation at the Longchuan County People’s Hospital between January 2019 and February 2022 were the subject of a retrospective analysis of their laboratory data. Patients were grouped based on length of hospital stay, septic shock, and mortality.Results: A total of 240 patients participated in our study. Using univariate and multivariate analysis, we identified several risk factors for gastrointestinal perforation associated with a dismal prognosis. Lower digestive tract perforation (OR=2.418, 95% CI 1.119– 5.227, P=0.025), low total protein (OR=0.934, 95% CI 0.879– 0.992, P=0.026) and low hemoglobin (OR=0.985, 95% CI 0.971– 0.999, P=0.039) were linked to a longer length of stay, especially hemoglobin (OR=0.978, 95% CI 0.966– 0.991, P=0.001) in upper digestive tract. High ratio of neutrophils to lymphocytes (NLR) (OR=1.043, 95% CI 1.012– 1.076, P=0.007), high lymphocyte-to-monocyte ratio (LMR) (OR=2.158, 95% CI 1.495– 3.115, P< 0.001) and low prognostic nutrition index (PNI) (OR=0.814, 95% CI 0.751– 0.833, P< 0.001) predicted septic shock. In upper digestive tract, PLR (OR=1.001, 95% CI 1.000– 1.002, P=0.067), LMR (OR=2.160, 95% CI 1.440– 3.240, P< 0.001) and PNI (OR=0.843, 95% CI 0.767– 0.926, P< 0.001) were risk factors for septic shock, and total protein (OR=0.796, 95% CI 0.686– 0.923, P=0.003) was a risk factor for septic shock in lower digestive tract. High NLR (OR=1.056, 95% CI 1.019– 1.093, P=0.003), high LMR (OR=1.760, 95% CI 1.177– 2.632, P=0.006) and low PNI (OR=0.832, 95% CI 0.754– 0.918, P< 0.001) were the risk factors of mortality. In subgroup analysis of perforation site, albumin (OR=0.820, 95% CI 0.719– 0.934, P=0.003) and LMR (OR=1.506, 95% CI 1.069– 2.123, P=0.019) were risk factors for mortality in upper digestive tract and PNI (OR=0.636, 95% CI 0.445– 0.908, P=0.013) was a risk factor for mortality in lower digestive tract.Conclusion: Our research found that the perforation site, total protein, albumin, hemoglobin, NLR, LMR, PLR and PNI were risk factors for gastrointestinal perforation with a poor prognosis.Keywords: gastrointestinal perforation, length of stay, septic shock, mortality, prognosis

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