Malekpour Alamdari Nasser, Afaghi Siamak, Esmaeili Tarki Farzad, Fathi Mohammad, Besharat Sara, Rahimi Fatemehsadat
Clinical Research and Development Center, Department of Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Research Institute of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2022 Aug 24;10(1):e69. doi: 10.22037/aaem.v10i1.1692. eCollection 2022.
Anal abscess is considered as a relatively common compilation in type 2 diabetes mellitus (T2DM) patients. This study aimed to determine the risk factors of recurrent anal abscess in T2DM patients.
In this 4-year retrospective cross-sectional study, T2DM patients hospitalized due to anal abscess in Shahid Modarres Hospital, Tehran, Iran from December 2016 to December 2020 were studied. The independent risk factors of disease recurrence were determined among demographic factors, underlying diseases, diabetes-related factors, clinical factors, laboratory parameters, abscess type, and culture using multivariate stepwise logistic regression analysis.
203 patients were enrolled in the study. 58 (28.6%) patients had at least one re-occurrence of anal abscess during four years. The recurrent episodes had occurred more frequently in the first year after the initial treatment (55.2%). The prevalence of comorbidities such as metabolic syndrome, coronary artery disease, chronic kidney disease, end stage renal disease, and peripheral vascular disease was significantly higher amongst patients with abscess recurrence. The patients with recurrent anal abscess had statically significant poor glycemic control (HbA1C > 7.5), decreased levels of Estimated Glomerular Filtration Rate (e-GFR), and higher C-reactive Protein (CRP) upon the first admission. Presence of metabolic syndrome, HbA1c > 7.5%, WBC > 11.0 ×10/L, and CRP > 5 mg/l were amongst the independent risk factors of recurrence. HbA1c > 7.5% was the greatest independent risk factor of anal abscess recurrence (OR=2.68, 95% CI: 1.37-5.25; p < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of HbA1C, CRP, and WBC in predicting the risk of abscess recurrence was 0.81, 0.71, and 0.64, respectively.
Th recurrence rate of anal abscess in this series was 28.6 %. It seems that in T2DM patients with uncontrolled diabetes who have metabolic syndrome and increased CRP and WBC in their routine tests, the probability of anal abscess reoccurrence is high.
肛门脓肿被认为是2型糖尿病（T2DM）患者中相对常见的并发症。本研究旨在确定T2DM患者复发性肛门脓肿的危险因素。
在这项为期4年的回顾性横断面研究中，对2016年12月至2020年12月期间在伊朗德黑兰沙希德·莫达雷斯医院因肛门脓肿住院的T2DM患者进行了研究。使用多变量逐步逻辑回归分析，在人口统计学因素、基础疾病、糖尿病相关因素、临床因素、实验室参数、脓肿类型和培养结果中确定疾病复发的独立危险因素。
203例患者纳入研究。58例（28.6%）患者在四年内至少有一次肛门脓肿复发。复发事件在初始治疗后的第一年更为频繁（55.2%）。脓肿复发患者中代谢综合征、冠状动脉疾病、慢性肾脏病、终末期肾病和外周血管疾病等合并症的患病率显著更高。复发性肛门脓肿患者在首次入院时血糖控制明显较差（糖化血红蛋白>7.5%），估算肾小球滤过率（e-GFR）水平降低，C反应蛋白（CRP）升高。代谢综合征的存在、糖化血红蛋白>7.5%、白细胞>11.0×10⁹/L和CRP>5mg/L是复发的独立危险因素。糖化血红蛋白>7.5%是肛门脓肿复发的最大独立危险因素（比值比=2.68，95%置信区间：1.37-5.25；p<0.001）。糖化血红蛋白、CRP和白细胞在预测脓肿复发风险时的受试者工作特征（ROC）曲线下面积（AUC）分别为0.81、0.71和0.64。
本系列中肛门脓肿的复发率为28.6%。似乎在糖尿病未得到控制、患有代谢综合征且常规检查中CRP和白细胞升高的T2DM患者中，肛门脓肿复发的可能性很高。
