Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system

Table 1 Compared the clinical and laboratory characteristics of the patients with low or high principal component score

Characteristics	Simple obstruction (n = 236)		P value	Strangulated obstruction (n = 45)		P value
	Low PC score	High PC score		Low PC score	High PC score
Baseline data
Gender, n (%)			1.0001			0.4212
Male	117 (69.2%)	39 (69.6%)		18 (52.9%)	8 (72.7%)
Female	52 (30.8%)	17 (30.4%)		16 (47.1%)	3 (27.3%)
Age (yr)	60 (47, 69)	65 (53, 71)	0.081	63 (52.25, 70.00)	(61.0, 71.5)	0.321
BMI (kg/m2)	20.70 (18.83, 22.98)	20.94 (18.21, 22.65)	0.196	20.20 (18.16, 22.00)	18.75 (17.72, 19.81)	0.228
Comorbidity, n (%)			0.2451			1.0002
None	128 (75.7%)	38 (67.9%)		27 (79.4%)	9 (81.8%)
Yes	41 (24.3%)	18 (32.1%)		7 (20.6%)	2 (18.2%)
Pain duration (d)	2 (1, 5)	6 (3, 12.5)	< 0.000	2.00 (1.00, 3.75)	2.0 (1.0, 4.0)	0.989
History of abdominal operation, n (%)			0.4711			0.6032
None	43 (25.4%)	17 (30.4%)		11 (32.4%)	2 (18.2%)
Yes	126 (74.6)	39 (69.6%)		23 (67.6%)	9 (81.8%)
Temperature (degrees Celsius)	36.6 (36.5, 36.8)	36.6 (36.5, 36.8)	0.401	36.6 (36.5, 36.8)	36.60 (36.50, 36.75)	0.956
CT characteristics
Mesenteric fluid (%)			0.430			0.9852
None	32 (18.9%)	8 (14.3%)		1 (2.9%)	1 (9.1%)
Yes	137 (81.1%)	48 (85.7%)		33 (97.1%)	10 (90.9%)
Ascites (%)			0.849			1.0002
None	58 (34.3%)	20 (35.7%)		4 (11.8%)	1 (9.1%)
Yes	111 (65.7%)	36 (64.3%)		30 (88.2%)	10 (90.9%)
Spiral signs (%)			0.6122			0.4362
None	151 (89.3%)	52 (92.9%)		22 (64.7%)	5 (45.5%)
Yes	18 (10.7%)	4 (7.1%)		12 (35.3%)	6 (54.5%)
Concentric circle sign (%)			0.1322			0.7452
None	164 (97.0%)	51 (91.1%)		31 (91.2%)	11 (100%)
Yes	5 (3.0%)	5 (8.9%)		3 (8.8%)	0 (0%)
Small bowel feces sign (%)			0.006			1.0002
None	70 (41.4%)	35 (62.5%)		17 (50.0%)	5 (45.5%)
Yes	99 (58.6%)	21 (37.5%)		17 (50.0%)	5 (54.5%)
Mural thickness (median)	3.28 (2.30, 3.75)	3.63 (2.97, 4.53)	0.002	3.51 (3.16, 4.12)	3.42 (2.67, 4.07)	0.634
Laboratory data
WBC (109/L)	6.770 (4.89, 9.52)	7.345 (4.87, 11.18)	0.387	8.70 (5.89, 12.23)	6.83 (10.01, 18.25)	0.384
NE%	75.50 (65.9, 83.3)	77.45 (68.5, 84.03)	0.422	83.60 (69.05, 86.90)	77.50 (73.30, 90.25)	0.853
Lymphocyte (109/L)	1.01 (0.74, 1.42)	0.94 (0.64, 1.34)	0.240	0.96 (0.65, 1.34)	0.60 (0.42, 0.76)	0.020
Monocyte (109/L)	0.420 (0.30, 0.58)	0.565 (0.34, 0.73)	0.011	0.570 (0.407, 0.735)	0.540 (0.33, 0.760)	0.721
NLR (ratio)	4.650 (3.03, 8.07)	6.115 (3.74, 9.30)	0.159	7.750 (4.085, 12.922)	9.030 (4.990, 15.565)	0.491
LMR (ratio)	2.286 (1.67, 3.42)	1.591 (1.13, 2.84)	0.002	1.681 (2.131, 1.141)	1.482 (0.957, 1.933)	0.459
Hb (g/L)	128.0 (115, 142)	120.5 (108, 133)	0.016	131.0 (110.0, 137.7)	129.0 (120.5, 145.0)	0.587
PLT (109/L)	205.5 (162.50, 250.75)	250.5 (180.25, 307.25)	0.002	213 (163, 260)	180.0 (152.0, 242.5)	0.256
Albumin (g/L)	35.9 (32.30, 40.45)	36.1 (31.80, 39.45)	0.403	34.6 (31.7, 39.6)	37.1 (28.6, 42.0)	0.977
ALT (U/L)	16 (11, 24)	16 (11, 22)	0.727	15.00 (12.00, 21.75)	15.00 (13.25, 27.75)	0.612
AST (U/L)	20 (16, 26)	21 (17, 25.5)	0.619	19.50 (17.00, 23.75)	36.50 (20.75, 45.25)	0.022
Ca (mmol/L)	2.19 (2.04,2.32)	2.15 (2.02,2.26)	0.152	2.19 (2.09, 2.31)	2.05 (1.95, 2.20)	0.062
Cl (mmol/L)	102.30 (100.0, 104.1)	100.15 (96.85, 104.03)	0.015	100.85 (98.13, 103.85)	102.00 (101.35, 104.15)	0.296
K (mmol/L)	4.035 (3.78, 4.34)	3.985 (3.74, 4.43)	0.957	4.00 (3.56, 4.31)	4.36 (3.62, 5.07)	0.290
Na (mmol/L)	138.40 (136.68, 140.48)	138.15 (135.50, 141.23)	0.533	138.05 (134.13, 140.30)	135.60 (134.75, 137.75)	0.334
BUN (mmol/L)	5.5 (4.3, 7.2)	5.4 (3.68, 8.23)	0.872	6.45 (4.00, 8.57)	10.6 (7.3, 15.3)	0.002
Glu (mmol/L)	6.78 (5.30, 8.67)	6.59 (5.16, 9.51)	0.515	8.165 (6.963, 9.300)	8.66 (6.78, 11.04)	0.428
PT (s)	13.6 (13.1, 14.3)	13.6 (13.28, 14.43)	0.825	13.45 (12.90, 13.90)	15.40 (14.20, 16.65)	0.004
APTT (s)	35.6 (33.3, 38.3)	36.1 (34.0, 40.9)	0.184	35.15 (32.18, 37.10)	41.6 (36.1, 45.0)	0.012
DDI (mg/L)	1.45 (0.71, 2.52)	1.94 (0.79, 4.67)	0.151	1.64 (0.88, 3.50)	5.75 (2.39, 6.72)	0.024
Fib (g/L)	3.49 (2.92, 4.37)	3.78 (3.25, 4.59)	0.150	3.69 (2.71, 4.60)	3.89 (3.17, 4.82)	0.548
Creatinine (umol/L)	70.0 (56, 81)	70.5 (54.75, 88.00)	0.512	67 (57, 76)	93 (80, 147)	0.003
Management			< 0.0002			0.2152
Conservative treatment	155 (91.7%)	17 (30.4%)		1 (2.9%)	0 (0%)
Laparoscopy	11 (6.5%)	8 (14.3%)		8 (23.5%)	0 (0%)
Laparotomy	3 (1.8%)	31 (55.4%)		25 (73.5%)	11 (100%)
CD, n (%)			< 0.0002			< 0.0002
Grade I	141 (83.4%)	20 (35.7%)		5 (14.7%)	0 (0%)
Grade II	28 (16.6%)	32 (57.1%)		28 (82.4%)	2 (18.2%)
Grade III	0 (0%)	1 (1.8%)		1 (2.9%)	0 (0%)
Grade IV	0 (0%)	3 (5.4%)		0 (0%)	9 (81.8%)
Grade V	0 (0%)	0 (0%)		0 (0%)	0 (0%)
SAE, n (%)			0.0182			< 0.0002
None	169 (100%)	53 (94.6%)		34 (100%)	2 (18.2%)
Yes	0 (0%)	3 (5.4%)		0 (0%)	9 (81.8%)
Fee (¥)	12070 (8830, 19935)	54322 (41370, 74623)	< 0.000	51828 (33575, 66954)	83553.0 (74146.0, 142409.5)	< 0.000
Length of stay (d)	5 (4, 8)	16 (13.75, 22.50)	< 0.000	14.00 (10.25, 17.00)	28.0 (18.5, 35.5)	< 0.000

¹were compared using the χ² test.

²were adjusted P values or Fisher’s exact test.

SiBO: Simple small bowel obstruction; StBO: Strangulated small bowel obstruction; PC score: Principle component score; BMI: Body mass index; WBC: White blood cell; NE%: Neutrophil percentage; NLR: Neutrophil to lymphocyte ratio; LMR: Lymphocyte to monocyte ratio; Hb: Hemoglobi; PLT: Platelet; ALT: Alanine aminotransferase, AST: Aspartate aminotransferase; Ca: Calcium; Cl: Chloride; K: Potassiun; Na: Sodium; BUN: Blood urea nitrogen; Glu: Glucose; PT: Prothrombin time; APTT: Activated partial thromboplastin time; DDI: D-dimer; Fib: Fibrinogen; CD: Clavien-Dindo; SAE: Severe adverse event.

Table 2 Univariate and multivariate analyses of risk factors for high principal component score

Characteristics	Simple obstruction (n = 236)				Strangulated obstruction (n = 45)
	Univariate		Multivariate		Univariate		Multivariate
	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Pain duration (d)	1.019 (1.002, 1.041)	0.0481
Small bowel feces sign (+)/(-)	0.424 (0.225, 0.783)	0.0061	0.316 (0.158, 0.612)	< 0.0001
Mural thickening (cm)	2.119 (1.084, 4.375)	0.0331	1.338 (1.098, 1.664)	0.0031
Lymphocyte (109/L)					0.097 (0.007, 0.665)	0.0381	0.071 (0.003, 0.539)	0.0331
Monocyte (109/L)	5.472 (1.809, 17.780)	0.0031
LMR (ratio)	0.708 (0.541, 0.891)	0.0061	0.656 (0.496, 0.836)	0.0011
Hb (g/L)	0.983 (0.969, 0.998)	0.0331
PLT (109/L)	1.003 (1.001, 1.007)	0.0361
AST (U/L)					1.075 (1.018, 1.156)	0.0271
Cl (mmol/L)	0.931 (0.871, 0.993)	0.0311
BUN (mmol/L)					1.383 (1.133, 1.786)	0.0041	1.478 (1.169, 2.061)	0.0041
PT (s)					1.568 (1.141, 2.418)	0.0151
APTT (s)					1.109 (0.999, 1.264)	0.076
DDI (mg/L)					1.196 (1.006, 1.513)	0.067
Creatinine (umol/L)					1.034 (1.011, 1.071)	0.0221

¹indicates that the parameters have statistical difference (P < 0.05).

SiBO: Simple small bowel obstruction; StBO: Strangulated small bowel obstruction; OR: Odds ratio; CI: Confidence interval; LMR: Lymphocyte to monocyte ratio; Hb: Hemoglobin; PLT: Platelet; AST: Aspartate aminotransferase; Cl: Chloride; BUN: Blood urea nitrogen; PT: Prothrombin time; APTT: Activated partial thromboplastin time; DDI: D-dimer.