Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting  

作　　者：Matthias Frank Scriba Eduard Jonas Galya Eileen Chinnery 

机构地区：[1]Department of Surgical Gastroenterology,Department of Surgery,Groote Schuur Hospital,University of Cape Town,Cape Town 7925,Western Cape,South Africa

出　　处：《World Journal of Gastrointestinal Pharmacology and Therapeutics》2024年第6期39-50,共12页世界胃肠药理与治疗学杂志（英文）

摘　　要：BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.

关 键 词：Corrosive injuries Caustic injuries ADULT Predicting necrosis Endoscopy predictive performance CT predictive performance Short-term survival 

分 类 号：R57[医药卫生—消化系统]