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Prognostic risk factors in upper gastrointestinal perforation: the role of body composition parameters
Teng Zhu1,2, Huayan Gu3, Yuefeng Chen1,2
1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Background:
Despite medical advances, the prognosis for upper gastrointestinal perforation remained poor. The aim of our study was to identify predictors of adverse outcomes.
Methods:
We retrospectively analyzed laboratory data from patients with upper gastrointestinal perforation at the First Affiliated Hospital of Wenzhou Medical University (January 2021-December 2023), categorizing them according to septic shock, intensive care unit (ICU) admission, and postoperative complications.
Results:
Univariate and multivariate analyses of 200 patients with upper gastrointestinal perforation identified predictors of a poor prognosis: low muscle reserve (OR = 3.82, 95% CI 1.36-10.71, p = 0.011), high visceral fat area (VFA) (OR = 3.54, 95% CI 1.16-10.80, p = 0.026), and platelet-to-lymphocyte ratio (PLR) (OR = 1.01, 95% CI 1.01-1.01, p = 0.048) predicted septic shock. Sex (OR = 0.22, 95% CI 0.06-0.78, p = 0.020), high VFA (OR = 4.84, 95% CI 1.38-17.02, p = 0.014), prothrombin time (PT) (OR = 1.54, 95% CI 1.09-2.18, p = 0.014), and D-dimer (OR = 1.16, 95% CI 1.01-1.34, p = 0.048) influenced ICU admission. Meanwhile, surgical approach (OR = 7.82, 95% CI 1.94-31.57, p = 0.004), maximum perforation diameter (OR = 1.08, 95% CI 1.02-1.15, p = 0.013), and white blood cell (WBC) count (OR = 0.88, 95% CI 0.78-0.99, p = 0.039) were linked to postoperative complications.
Conclusion:
Our research found that the following factors were prognostic for upper gastrointestinal perforation: low muscle reserve, high VFA, PLR, sex, PT, D-dimer levels, surgical approach, WBC count, and perforation size.
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