Wang Yongjie, Li Xiaolu, Yu Yanyan, Liang Jian
Department of Critical Care Medicine, Jilin Provincial People's Hospital, Changchun, China.
Intensive Care Unit, Chifeng Municipal Hospital of Inner Mongolia, Chifeng, China.
J Gastrointest Oncol. 2023 Apr 29;14(2):806-814. doi: 10.21037/jgo-23-205.
Colorectal cancer is the most common gastrointestinal tumor. Gastrointestinal perforation is a common complication of colorectal cancer, resulting in peritonitis, abdominal abscess, and sepsis, and can eventually lead to death. The present study aimed to investigate the risk factors for sepsis in patients with colorectal cancer complicated with gastrointestinal perforation and its impact on prognosis.
From January 2016 to December 2017, 126 patients with colorectal cancer complicated with gastrointestinal perforation admitted to the Dazu Hospital of Chongqing Medical University were retrospectively and continuously collected. The patients were divided into a sepsis group (n=56) and a control group (n=70) according to whether they developed sepsis or not. The clinical characteristics of the two groups were analyzed, and multivariate logistic regression analysis was performed to explore the risk factors of sepsis in patients with colorectal cancer complicated with gastrointestinal perforation. Finally, the impact of sepsis on the prognosis of patients was analyzed.
The multivariate logistic regression analysis showed that anemia, intestinal obstruction, preoperative chemotherapy, acidosis, and albumin <30 g/L were independent risk factors for sepsis in colorectal cancer patients complicated with gastrointestinal perforation (P<0.05). Albumin was valuable in predicting the absence of sepsis in colorectal cancer patients complicated with gastrointestinal perforation, and the area under the curve was 0.751 (95% confidence interval: 0.666-0.835). R4.0.3 statistical software was used to randomly divide the dataset into training and validation sets, with a sample size of 88 in the training set and 38 in the validation set. The areas under the receiver operating characteristic curves of the training and validation sets were 0.857 (95% confidence interval: 0.776-0.938) and 0.735 (95% confidence interval: 0.568-0.902), respectively. The Hosmer-Lemeshow Goodness-of-Fit Test was performed in the validation set; the chi-square value was 10.274 and the P value was 0.246, which indicated that the model had good confidence in predicting sepsis.
Patients with colorectal cancer complicated by gastrointestinal perforation have a high incidence of sepsis, which can lead to a poor prognosis. The model presented in this study can effectively identify patients with a high risk of sepsis.
结直肠癌是最常见的胃肠道肿瘤。胃肠道穿孔是结直肠癌的常见并发症，可导致腹膜炎、腹腔脓肿和脓毒症，最终可能导致死亡。本研究旨在探讨结直肠癌合并胃肠道穿孔患者发生脓毒症的危险因素及其对预后的影响。
回顾性连续收集2016年1月至2017年12月重庆医科大学附属大足医院收治的126例结直肠癌合并胃肠道穿孔患者。根据是否发生脓毒症将患者分为脓毒症组（n = 56）和对照组（n = 70）。分析两组患者的临床特征，并进行多因素logistic回归分析，以探讨结直肠癌合并胃肠道穿孔患者发生脓毒症的危险因素。最后，分析脓毒症对患者预后的影响。
多因素logistic回归分析显示，贫血、肠梗阻、术前化疗、酸中毒和白蛋白<30 g/L是结直肠癌合并胃肠道穿孔患者发生脓毒症的独立危险因素（P<0.05）。白蛋白对预测结直肠癌合并胃肠道穿孔患者未发生脓毒症具有重要价值，曲线下面积为0.751（95%置信区间：0.666 - 0.835）。采用R4.0.3统计软件将数据集随机分为训练集和验证集，训练集样本量为88例，验证集样本量为38例。训练集和验证集的受试者工作特征曲线下面积分别为0.857（95%置信区间：0.776 - 0.938）和0.735（95%置信区间：0.568 - 0.902）。在验证集中进行Hosmer-Lemeshow拟合优度检验；卡方值为10.274，P值为0.246，表明该模型对脓毒症的预测具有良好的可信度。
结直肠癌合并胃肠道穿孔患者脓毒症发生率高，可导致预后不良。本研究提出的模型可有效识别脓毒症高危患者。
