Caustic ingestion: development and validation of a prognostic score.

Area of Science:

• Gastroenterology
• Toxicology
• Emergency Medicine

Background:

• Caustic ingestion presents a severe health risk, necessitating early identification of patients with poor prognoses.
• Endoscopic evaluation alone may overestimate the severity of caustic ingestion injuries.
• Developing a reliable prognostic tool is crucial for optimizing patient management.

Purpose of the Study:

• To develop and validate a prognostic score for predicting adverse outcomes in patients with caustic ingestion.
• To enhance the accuracy of severity assessment beyond traditional endoscopic findings.

Main Methods:

• A prospective cohort study included 469 patients aged over 15 years with caustic ingestion from 1995 to 2017.
• Clinical, analytical, and endoscopic variables were analyzed to identify independent risk factors for adverse outcomes (ICU admission, urgent surgery, or death).
• Logistic regression was used to develop a prognostic score, internally validated by bootstrapping and externally validated on an independent cohort.

Main Results:

• Acidic substance ingestion, elevated neutrophil count, metabolic acidosis (low bicarbonate), and endoscopic injury were identified as independent risk factors for poor outcomes.
• The developed prognostic score demonstrated superior accuracy compared to endoscopy alone (P=0.04).
• The score achieved high sensitivity (93.3%), specificity (92.7%), and an area under the curve of 0.976, indicating excellent predictive performance.

Conclusions:

• A novel prognostic score reliably predicts outcomes in caustic ingestion.
• This score offers a more accurate assessment of severity than endoscopy alone.
• The validated score can significantly improve the early management of caustic ingestion patients.