J Korean Soc Emerg Med.  2020 Jun;31(3):291-297.

Initial risk factors associated with in-hospital mortality after surgery in adult patients admitted to emergency department with gastrointestinal perforation

• Bae Y
• Kim JH
• Cha K
• Kim HJ

Abstract

Objective
Gastrointestinal perforation (GIP) is a life-threatening disease with a high mortality rate. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are recognized markers of inflammation associated with poor outcomes in a range of clinical situations. The study aimed to identify the independent risk factors with in-hospital mortality and examine the association of initial NLR and PLR with mortality in adult patients with GIP undergoing surgery.
Methods
This was a multi-center retrospective observational study. This study reviewed the electronic medical records of adult patients with GIP admitted to three academic hospitals between January 2009 and December 2018, who underwent surgery. The demographic and clinical data of the GIP patients were obtained. A multivariate logistic regression model was used to evaluate the risk factors associated with in-hospital mortality and to determine the association between the initial NLR and PLR and in-hospital mortality. The primary outcome was all-cause in-hospital mortality.
Results
Among the 9,279 patients, 879 adult patients with GIP underwent surgery. Seventy-eight patients (8.9%) died and 801 (91.1%) survived. Multivariate logistic regression analysis revealed female, underlying chronic renal failure, Creactive protein≥100 mg/L, and albumin<3.5 g/dL to be factors associated with in-hospital mortality (adjusted odds ratio [95% confidence interval], 2.73 [1.07-6.97], 4.20 [1.83-9.68], 8.43 [2.29-31.03], and 5.36 [2.29-12.59], respectively).
Conclusion
In adult patients with GIP receiving surgery, female, underlying chronic renal failure, initial high C-reactive protein, and low albumin might be independent risk factors associated with in-hospital mortality. The initial NLR and PLR were not found to be associated with mortality.

Keyword

Gastrointestinal perforation; Mortality; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Risk factors