Kudou Kensuke, Kajiwara Shuhei, Motomura Takashi, Yukaya Takafumi, Nakanoko Tomonori, Kuroda Yosuke, Okamoto Masahiro, Koga Tadashi, Yamashita Yo-Ichi, Shimokawa Mototsugu, Oki Eiji, Yoshizumi Tomoharu
Department of Surgery, Iizuka Hospital, 3-83 Yoshio-Machi, Iizuka, Fukuoka, 820-8505, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Surg Today. 2025 Feb 3. doi: 10.1007/s00595-025-03002-4.
Colorectal necrosis is a serious condition associated with high morbidity and mortality. We investigated the clinical features and prognostic factors of patients who underwent emergency surgery for colorectal necrosis.
Data from 40 patients who underwent surgery for colorectal necrosis were reviewed retrospectively to assess the various clinical and operative factors and risk factors for hospital mortality.
The Kaplan-Meier method showed that total colectomy, a platelet count < 100,000/μL, a prothrombin time-international normalized ratio ≥ 1.5, creatine kinase ≥ 566 U/L, lactate ≥ 22.8 mg/dL, base excess < - 12 mmol/L, platelet-lymphocyte ratio < 321, and C-reactive protein/albumin ratio < 1.0 were significantly associated with poor prognosis. Multivariate analyses identified that a platelet count < 100,000/μL (hazard ratio = 7.101, p = 0.0070) and base excess < -12 mmol/L (hazard ratio = 3.663, p = 0.0464) were independent predictive factors for hospital mortality in patients with colorectal necrosis. We established a novel prognostic score based on platelet count, creatine kinase, and base excess. Patients with a novel prognostic score ≥ 4 had significantly poorer survival rates than patients with a score ≤ 3 (0.0% vs. 73.4%, p < 0.001).
A platelet count < 100,000/μL and base excess < - 12 mmol/L are associated with a poor prognosis for patients with colorectal necrosis. This novel prognostic score may be a more accurate prognostic factor for patients with colorectal necrosis.
结直肠坏死是一种严重疾病，发病率和死亡率都很高。我们调查了因结直肠坏死接受急诊手术患者的临床特征和预后因素。
回顾性分析40例因结直肠坏死接受手术患者的数据，以评估各种临床、手术因素及医院死亡的危险因素。
Kaplan-Meier法显示，全结肠切除术、血小板计数<100,000/μL、凝血酶原时间-国际标准化比值≥1.5、肌酸激酶≥566 U/L、乳酸≥22.8 mg/dL、碱剩余<-12 mmol/L、血小板-淋巴细胞比值<321以及C反应蛋白/白蛋白比值<1.0与预后不良显著相关。多因素分析确定，血小板计数<100,000/μL（风险比=7.101，p=0.0070）和碱剩余<-12 mmol/L（风险比=3.663，p=0.0464）是结直肠坏死患者医院死亡的独立预测因素。我们基于血小板计数、肌酸激酶和碱剩余建立了一种新的预后评分。新预后评分≥4的患者生存率明显低于评分≤3的患者（0.0%对73.4%，p<0.001）。
血小板计数<100,000/μL和碱剩余<-12 mmol/L与结直肠坏死患者预后不良相关。这种新的预后评分可能是结直肠坏死患者更准确的预后因素。
