A new model for prediction of bowel gangrene in sigmoid volvulus

BACKGROUND: Sigmoid volvulus is a pathology that can be mortal because it is frequently encountered in elderly patients. In case of bowel gangrene, mortality and morbidity increase further. We planned a retrospective study, in which the effectiveness of the model was evaluated by creating a model that aims to predict whether intestinal gangrene is present in patients with sigmoid volvulus only by blood tests and thus to quickly guide treatment methods. METHODS: In addition to demographic data such as age and gender, laboratory values such as white blood cell, C-reactive protein (CRP), lactate dehydrogenase (LDH), potassium, and colonoscopic findings and whether there was gangrene in the colon during the operation were evaluated retrospectively. In the analysis of the data, independent risk factors were determined by univariate and multivariate logistic regression analyzes as well as Mann–Whitney U and Chi-square tests. Receiver operating characteristic (ROC) analysis was performed for statistically significant continuous numerical data, and cutoff values were determined and Malatya Volvulus Gangrene Model (MVGM) was created. The effectiveness of the created model was again evaluated by ROC analysis. RESULTS: Of the 74 patients included in the study, 59 (79.7%) were male. The median age of the population was 74 (19–88), and gangrene was detected in 21 (28.37%) patients at surgery. In univariate analyzes, leukocytes <4000/mm3 and >12000/mm3 (OR: 10.737; CI 95%: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI 95%: 2.520–26.082, p<0.0001), potassium ≥3.85 mmoL/L (OR: 3.889; 95% CI): 1.333–11.345, p=0.013), and LDH ≥288 U/L (OR: 3.889; CI 95%: 1.333–11.345, p=0.013), whereas, in multivariate analyzes, only CRP ≥0.71 mg/dL (OR: 3.965; CI 95%: 1.071–15.462, p=0.047) was found to be an independent risk factor for bowel gangrene. The strength of MVGM was AUC 0.836 (0.737–0.936). In addition, it was observed that the probability of bowel gangrene increased approximately 10 times if MVGM was ≥7 (OR: 9.846; 95% CI: 3.016–32.145, p<0.0001). CONCLUSION: Besides being non-invasive compared to the colonoscopic procedure, MVGM is a useful method for detecting bowel gangrene. In addition, it will guide the clinician in taking the patients with intestinal loop gangrene to emergency surgery without wasting time in the treatment steps, as well as avoiding complications that may occur during colonoscopy. In this way, we think that morbidity and mortality rates can be reduced.

Anahtar Kelime:

Sigmoid volvulus’ta bağırsak gangreninin tahmininde yeni bir model

Öz:

AMAÇ: Sigmoid volvulus yaşlı hastalarda sık görülmesi nedeniyle mortal seyreden bir patolojidir. Bağırsak gangreni durumunda mortalite ve morbidite daha da artmaktadır. Sigmoid volvuluslu hastalarda bağırsak gangreni olup olmadığını sadece kan tahlileri ile tahmin etmeyi ve böylece tedavi yöntemlerine hızlı bir şekilde rehberlik etmeyi amaçlayan bir model oluşturarak modelin etkinliğinin değerlendirildiği geriye dönük bir çalışma planladık. GEREÇ VE YÖNTEM: Kliniğimizde 1999–2021 tarihleri arasında sigmoid volvulus nedeniyle opere edilen hastaların yaş, cinsiyet gibi demografik verilerinin yanında white blood cell (WBC), C-reaktif protein (CRP), LDH, potasyum gibi labaratuar değerleri, kolonoskopik bulgulara ve operasyonda kolonda gangren olup olmadığı geriye dönük olarak incelendi. Verilerin analizinde Mann-Whitney U ve ki-kare testlerinin yanısıra Univariate ve Multivariate Logistic Regresyon analizleri ile bağımsız risk faktörü belirlendi. İstatistiksel olarak anlamlı olan sürekli sayısal veriler için ROC analizi yapılarak cut off değerleri belirlendi ve Malatya Volvulus Gangren Modeli (MVGM) oluşturuldu. Oluşturulan modelin etkinliği yine ROC analizi ile değerlendirildi. BULGULAR: Çalışmaya alınan 74 hastanın 59’u (%79.7) erkekti. Popülasyonun ortanca yaşı 74 (19–88) olmasının yanısıra ameliyatta 21 (%28.37) hastada gangren tespit edildi. Tek değişkenli analizlerde lökositler <4000/mm3 ve >12000/mm3 (OR: 10.737; CI %95: 2.797–41.211, p=0.001), CRP ≥0.71 mg/dl (OR: 8.107 CI %95: 2.520–26.082, p<0.0001), potasyum ≥3.85 mmol/L (OR: 3.889; %95 GA): 1.333–11.345, p=0.013) ve LDH ≥288 U/L (OR: 3.889; CI %95: 1.333–11.345, p=0.013), çok değişkenli analizlerde ise sadece CRP ≥0.71 mg/dl (OR: 3.965; CI %95: 1.071– 15.462), p=0.047) bağırsak gangreni için bağımsız bir risk faktörü olarak bulundu. MVGM’nin gücü AUC 0.836 (0.737–0.936) idi. Ayrıca MVGM ≥7 ise (OR: 9.846; %95 GA: 3.016–32.145, p<0.0001) bağırsak kangreni olasılığının yaklaşık 10 kat arttığı gözlendi. TARTIŞMA: Kolonoskopik işleme kıyasla noninvaziv olmasının yanında MVGM, bağırsak gangrenini tespit etmede kullanışlı bir yöntemdir. Ayrıca bağırsak ansı gangrene giden hastaların tedavi basamaklarında vakit kaybetmeden acil ameliyata alınmasında klinisyeni yönlendirmekle birlikte kolonoskopi esnasında meydana gelebilecek komplikasyonlardan da uzak durulmasını sağlayacaktır. Bu sayede morbidite ve mortalite oranlarının azaltılabileceğini düşünmekteyiz.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	ceylan c, Baran N, Kocaaslan H, Güngörür Ö, CENGİZ E, Güzel M, ANGIN Y, SAĞLAM K, AYDIN C (2023). A new model for prediction of bowel gangrene in sigmoid volvulus. , 471 - 476. 10.14744/tjtes.2022.11893
Chicago	ceylan cengiz,Baran N. Tolga,Kocaaslan Huseyin,Güngörür Ömer,CENGİZ Emrah,Güzel Mehmet,ANGIN YAVUZ SELIM,SAĞLAM KUTAY,AYDIN CEMALETTİN A new model for prediction of bowel gangrene in sigmoid volvulus. (2023): 471 - 476. 10.14744/tjtes.2022.11893
MLA	ceylan cengiz,Baran N. Tolga,Kocaaslan Huseyin,Güngörür Ömer,CENGİZ Emrah,Güzel Mehmet,ANGIN YAVUZ SELIM,SAĞLAM KUTAY,AYDIN CEMALETTİN A new model for prediction of bowel gangrene in sigmoid volvulus. , 2023, ss.471 - 476. 10.14744/tjtes.2022.11893
AMA	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C A new model for prediction of bowel gangrene in sigmoid volvulus. . 2023; 471 - 476. 10.14744/tjtes.2022.11893
Vancouver	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C A new model for prediction of bowel gangrene in sigmoid volvulus. . 2023; 471 - 476. 10.14744/tjtes.2022.11893
IEEE	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C "A new model for prediction of bowel gangrene in sigmoid volvulus." , ss.471 - 476, 2023. 10.14744/tjtes.2022.11893
ISNAD	ceylan, cengiz vd. "A new model for prediction of bowel gangrene in sigmoid volvulus". (2023), 471-476. https://doi.org/10.14744/tjtes.2022.11893

APA	ceylan c, Baran N, Kocaaslan H, Güngörür Ö, CENGİZ E, Güzel M, ANGIN Y, SAĞLAM K, AYDIN C (2023). A new model for prediction of bowel gangrene in sigmoid volvulus. Ulusal Travma ve Acil Cerrahi Dergisi, 29(4), 471 - 476. 10.14744/tjtes.2022.11893
Chicago	ceylan cengiz,Baran N. Tolga,Kocaaslan Huseyin,Güngörür Ömer,CENGİZ Emrah,Güzel Mehmet,ANGIN YAVUZ SELIM,SAĞLAM KUTAY,AYDIN CEMALETTİN A new model for prediction of bowel gangrene in sigmoid volvulus. Ulusal Travma ve Acil Cerrahi Dergisi 29, no.4 (2023): 471 - 476. 10.14744/tjtes.2022.11893
MLA	ceylan cengiz,Baran N. Tolga,Kocaaslan Huseyin,Güngörür Ömer,CENGİZ Emrah,Güzel Mehmet,ANGIN YAVUZ SELIM,SAĞLAM KUTAY,AYDIN CEMALETTİN A new model for prediction of bowel gangrene in sigmoid volvulus. Ulusal Travma ve Acil Cerrahi Dergisi, vol.29, no.4, 2023, ss.471 - 476. 10.14744/tjtes.2022.11893
AMA	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C A new model for prediction of bowel gangrene in sigmoid volvulus. Ulusal Travma ve Acil Cerrahi Dergisi. 2023; 29(4): 471 - 476. 10.14744/tjtes.2022.11893
Vancouver	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C A new model for prediction of bowel gangrene in sigmoid volvulus. Ulusal Travma ve Acil Cerrahi Dergisi. 2023; 29(4): 471 - 476. 10.14744/tjtes.2022.11893
IEEE	ceylan c,Baran N,Kocaaslan H,Güngörür Ö,CENGİZ E,Güzel M,ANGIN Y,SAĞLAM K,AYDIN C "A new model for prediction of bowel gangrene in sigmoid volvulus." Ulusal Travma ve Acil Cerrahi Dergisi, 29, ss.471 - 476, 2023. 10.14744/tjtes.2022.11893
ISNAD	ceylan, cengiz vd. "A new model for prediction of bowel gangrene in sigmoid volvulus". Ulusal Travma ve Acil Cerrahi Dergisi 29/4 (2023), 471-476. https://doi.org/10.14744/tjtes.2022.11893