Sigmoid volvulus’ta baðýrsak gangreninin tahmininde yeni bir model

AMAÇ: Sigmoid volvulus yaþlý hastalarda sýk görülmesi nedeniyle mortal seyreden bir patolojidir. Baðýrsak gangreni durumunda mortalite ve morbidite daha da artmaktadýr. Sigmoid volvuluslu hastalarda baðýrsak gangreni olup olmadýðýný sadece kan tahlileri ile tahmin etmeyi ve böylece tedavi yön-temlerine hýzlý bir þekilde rehberlik etmeyi amaçlayan bir model oluþturarak modelin etkinliðinin deðerlendirildiði geriye dönük bir çalýþma planladýk. GEREÇ VE YÖNTEM: Kliniðimizde 1999–2021 tarihleri arasýnda sigmoid volvulus nedeniyle opere edilen hastalarýn yaþ, cinsiyet gibi demografik verilerinin yanýnda white blood cell (WBC), C-reaktif protein (CRP), LDH, potasyum gibi labaratuar deðerleri, kolonoskopik bulgulara ve operas-yonda kolonda gangren olup olmadýðý geriye dönük olarak incelendi. Verilerin analizinde Mann-Whitney U ve ki-kare testlerinin yanýsýra Univariate ve Multivariate Logistic Regresyon analizleri ile baðýmsýz risk faktörü belirlendi. Ýstatistiksel olarak anlamlý olan sürekli sayýsal veriler için ROC analizi yapýlarak cut off deðerleri belirlendi ve Malatya Volvulus Gangren Modeli (MVGM) oluþturuldu. Oluþturulan modelin etkinliði yine ROC analizi ile deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 74 hastanýn 59’u (%79.7) erkekti. Popülasyonun ortanca yaþý 74 (19–88) olmasýnýn yanýsýra ameliyatta 21 (%28.37) hastada gangren tespit edildi. Tek deðiþkenli analizlerde lökositler <4000/mm3 ve >12000/mm3 (OR: 10.737; CI %95: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI %95: 2.520–26.082, p<0.0001), potasyum ≥3.85 mmol/L (OR: 3.889; %95 GA): 1.333–11.345, p=0.013) ve LDH ≥288 U/L (OR: 3.889; CI %95: 1.333–11.345, p=0.013), çok deðiþkenli analizlerde ise sadece CRP ≥0.71 mg/dl (OR: 3.965; CI %95: 1.071–15.462), p=0.047) baðýrsak gangreni için baðýmsýz bir risk faktörü olarak bulundu. MVGM’nin gücü AUC 0.836 (0.737–0.936) idi. Ayrýca MVGM ≥7 ise (OR: 9.846; %95 GA: 3.016–32.145, p<0.0001) baðýrsak kangreni olasýlýðýnýn yaklaþýk 10 kat arttýðý gözlendi.
TARTIÞMA: Kolonoskopik iþleme kýyasla noninvaziv olmasýnýn yanýnda MVGM, baðýrsak gangrenini tespit etmede kullanýþlý bir yöntemdir. Ayrý-ca baðýrsak ansý gangrene giden hastalarýn tedavi basamaklarýnda vakit kaybetmeden acil ameliyata alýnmasýnda klinisyeni yönlendirmekle birlikte kolonoskopi esnasýnda meydana gelebilecek komplikasyonlardan da uzak durulmasýný saðlayacaktýr. Bu sayede morbidite ve mortalite oranlarýnýn azaltýlabileceðini düþünmekteyiz.

A new model for prediction of bowel gangrene in sigmoid volvulus

BACKGROUND: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods.
METHODS: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann–Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis.
RESULTS: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19–88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520–26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333–11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333–11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071–15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737–0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016–32.145, p<0.0001).
CONCLUSION: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.