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위장관 천공으로 응급실에 내원하여 수술받은 성인 환자에서 병원내 사망과 연관된 초기 위험인자

Initial risk factors associated with in-hospital mortality after surgery in adult patients admitted to emergency department with gastrointestinal perforation

대한응급의학회지 2020년 31권 3호 p.291 ~ 297
배영훈 ( Bae Yeong-Hoon ) - Catholic University College of Medicine Department of Emergency Medicine

김지훈 ( Kim Ji-Hoon ) - Catholic University College of Medicine Department of Emergency Medicine
차경만 ( Cha Kyung-Man ) - Catholic University College of Medicine Department of Emergency Medicine
 ( Kim Hyo-Joon ) - Catholic University College of Medicine Department of Emergency Medicine

Abstract


Objective: Gastrointestinal perforation (GIP) is a life-threatening disease with a high mortality rate. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are recognized markers of inflammation associated with poor outcomes in a range of clinical situations. The study aimed to identify the independent risk factors with in-hospital mortality and examine the association of initial NLR and PLR with mortality in adult patients with GIP undergoing surgery.

Method: This was a multi-center retrospective observational study. This study reviewed the electronic medical records of adult patients with GIP admitted to three academic hospitals between January 2009 and December 2018, who underwent surgery. The demographic and clinical data of the GIP patients were obtained. A multivariate logistic regression model was used to evaluate the risk factors associated with in-hospital mortality and to determine the association between the initial NLR and PLR and in-hospital mortality. The primary outcome was all-cause in-hospital mortality.

Results: Among the 9,279 patients, 879 adult patients with GIP underwent surgery. Seventy-eight patients (8.9%) died and 801 (91.1%) survived. Multivariate logistic regression analysis revealed female, underlying chronic renal failure, Creactive protein≥100 mg/L, and albumin<3.5 g/dL to be factors associated with in-hospital mortality (adjusted odds ratio [95% confidence interval], 2.73 [1.07-6.97], 4.20 [1.83-9.68], 8.43 [2.29-31.03], and 5.36 [2.29-12.59], respectively).

Conclusion: In adult patients with GIP receiving surgery, female, underlying chronic renal failure, initial high C-reactive protein, and low albumin might be independent risk factors associated with in-hospital mortality. The initial NLR and PLR were not found to be associated with mortality.

키워드

Gastrointestinal perforation; Mortality; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Risk factors
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