Scriba MF, Jonas E, Chinnery GE. Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting. World J Gastrointest Pharmacol Ther 2024; 15(6): 99097 [DOI: 10.4292/wjgpt.v15.i6.99097]
Corresponding Author of This Article
Matthias Frank Scriba, MBChB, MMed, Surgeon, Department of Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa. matthias.scriba@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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Table 5 Outcomes for 30-days post corrosive ingestion. Acute admission outcomes
Outcomes (n = 100)
n
%
30-day mortality
14
14.0
30-day morbidity
27
27.0
Required ICU management
26
26.0
Median (IQR) ICU stay
2.5 (2-3.25) days
Median (IQR) length of hospital stay
6 (2-15.5) days
Acute morbidities specified (n = 39)
Pneumonia (nosocomial)
7
17.9
Acute kidney injury
5
12.8
Cardiac arrest (unexpected)
4
10.3
Refeeding syndrome
3
7.7
Systemic sepsis
2
5.1
Unplanned extubation
2
5.1
Surgical site infection
2
5.1
Other
14
35.9
Table 6 Multivariate analysis of numerous admission variables in predicting full thickness necrosis and short-term mortality, n (%)
Variables
Predicting full thickness necrosis
Predicting acute mortality
Total, n
No FT necrosis
FT necrosis
P value
ROC AUC
No mortality
Mortality
P value
ROC AUC
Gender
Female
35
31
88.6
4
11.4
0.279
28
80.0
7
20.0
0.207
Male
65
52
80
13
20
58
89.2
7
10.8
At least one comorbidity
No
67
58
86.6
9
13.4
0.178
56
83.6
11
16.4
0.323
Yes
33
25
75.8
8
24.2
30
90.9
3
9.1
Known psychiatric history
No
85
71
83.5
14
16.5
0.739
72
84.7
13
15.3
0.377
Yes
15
12
80
3
20
14
93.3
1
6.7
Known HIV positive
No
88
75
85.2
13
14.8
0.11
74
84.1
14
15.9
0.138
Yes
12
8
66.7
4
33.3
12
100.0
0
0.0
Prior corrosive/suicide attempt
No
89
75
84.3
14
15.7
0.339
77
86.5
12
13.5
0.673
Yes
11
8
72.7
3
27.3
9
81.8
2
18.2
Needing endotracheal intubation
No
82
71
86.6
11
13.4
0.043
0.604
69
84.1
13
15.9
0.257
Yes
18
12
66.7
6
33.3
17
94.4
1
5.6
Needing chest compressions
No
99
83
83.8
16
16.2
0.027
0.529
85
85.9
14
14.1
0.687
Yes
1
0
0
1
100
1
100.0
0
0.0
Needing inotropes/vasopressors
No
97
81
83.5
16
16.5
0.447
83
85.6
14
14.4
0.480
Yes
3
2
66.7
1
33.3
3
100.0
0
0.0
≥ Zargar IIIB endoscopic findings
No
79
75
94.9
4
5.1
< 0.001
0.85
74
93.7
5
6.3
< 0.001
0.759
Yes
16
4
25
12
75
8
50.0
8
50.0
Grade 3 CT Findings
No
12
10
83.3
2
16.7
0.016
0.788
11
91.7
1
8.3
0.026
0.798
Yes
5
1
20
4
80
2
40.0
3
60.0
Age (years)
100
31 (24-38)
39 (30-50)
0.015
0.687
32 (24-40)
31 (25-40)
0.917
Systolic BP (mmHg)
48
134 (114-143)
129 (113-149)
0.926
130 (113-144)
134 (120-137)
0.919
Diastolic BP (mmHg)
48
80 (73-90)
83 (75-97)
0.309
82 (73-90)
79 (64-91)
0.520
Heart rate (beats per minute)
48
94 (79-109)
86 (72-105)
0.405
93 (76-110)
94 (82-107)
0.965
Urea (mmol/L)
79
4.6 (3.3-5.9)
5.1 (2.7-7.1)
0.686
4.7 (3.2-6.5)
3.9 (3.4-5.4)
0.432
Creatinine (umol/L)
88
70 (57-81)
84 (68-102)
0.038
0.666
72 (58-85)
72 (66-84)
0.892
WCC (× 109/L)
85
14.07 (9.58-18.31)
13.80 (9.76-19.16)
0.695
13.79 (9.59-18.31)
15.75 (10.63-20.50)
0.605
Platelets (× 109/L)
81
253 (210-326)
206 (171-266)
0.045
0.666
245 (194-308)
263 (232-375)
0.142
Calcium (mmol/L)
12
2.21 (2.00-2.35)
1.99 (199-1.99)
0.31
2.15 (1.99-2.35)
2.21 (2.21-2.21)
0.885
pH
41
7.37 (7.31-7.42)
7.13 (7.07-7.35)
0.003
0.823
7.35 (7.17-7.40)
7.36 (7.27-7.43)
0.593
Base excess (mEq/L)
40
-0.50 (-5.50-2.10)
-14.20 (-17.00 to -4.60)
0.004
0.819
-3.2 (-12.1-0.65)
2.45 (-0.58-5.38)
0.020
0.199
Lactate (mmol/L)
40
1.80 (1.20-3.30)
3.20 (2.60-4.45)
0.026
0.746
2.45 (1.20-3.55)
1.55 (1.18-3.48)
0.677
Ingestion to first assessment (hours)
94
6.0 (2.5-14.5)
4.0 (2.0-8.5)
0.209
6.0 (3.0-15.5)
3.0 (1.5-6.5)
0.052
Table 7 Admission endoscopy, computed tomography and blood gas performance in predicting full thickness necrosis
Total
FT necrosis
Not FT necrosis
Sensitivity, %
Specificity, %
PPV, %
NPV, %
P value
ROC AUC
Endoscopy performance (n = 95)
Zargar IIIB
16
12
4
75.0
94.9
75.0
94.5
< 0.001
0.850
CT performance (n = 17)
CT grade 3
5
4
1
66.7
90.9
80.0
83.3
0.026
0.788
Blood gas performance (n = 40)
pH < 7.35
20
7
13
77.8
58.1
35.0
90.0
0.062
0.679
BE < -2 mEq/L
18
7
11
77.8
64.5
38.9
90.9
0.027
0.711
Lactate > 2.0 mmol/L
21
8
13
88.9
58.1
38.1
94.7
0.014
0.735
Blood gas performance (Patients with concomitant toxin ingestion removed) (n = 35)
pH < 7.35
19
7
12
77.8
58.1
35.0
100.0
0.007
0.786
BE < -2 mEq/L
17
7
10
77.8
58.1
35.0
100.0
0.003
0.821
Lactate > 2.0 mmol/L
18
6
12
77.8
58.1
35.0
94.1
0.046
0.714
Citation: Scriba MF, Jonas E, Chinnery GE. Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting. World J Gastrointest Pharmacol Ther 2024; 15(6): 99097