What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?
OBJECTIVE
Despite the increasing use of early esophagogastroduodenoscopy, the prognostic evaluation and triage of patients who have ingested caustic material is challenging. We evaluated the usefulness of selected clinical and endoscopic parameters in predicting the risk of death after ingestion of caustic substances.


METHODS
Clinical and endoscopic parameters were obtained from the records of all the patients admitted to our endoscopy unit because of ingestion of caustic material between 1 March 1982 and 30 June 1999. Parameters significantly associated with the risk of death by univariate analysis were entered into a multivariate logistic model. The independent predictors of death by multivariate analysis were used to build a risk score system.


RESULTS
Out of 210 patients, 13 underwent emergency surgery (6.2 %) and 25 died (11.9 %). Multivariate analysis identified the following as independent predictors of death: age (10-year intervals; odds ratio [OR] 2.4; 95 % confidence interval 1.4 - 4.1), ingestion of strong acids (OR 7.9; 1.8 - 35.3), white blood cell count at admission > or = 20 000 units/mm3 (OR 6.0; 1.3-28), deep gastric ulcers (OR 9.7; 1.4 - 66.8), and gastric necrosis (OR 20.9; 4.7 - 91.8). The values of the risk score system devised from the results of the multivariate analysis ranged from 1 to 16. No patient scoring < 10 points died and just one of the patients scoring > 14 points survived.


CONCLUSIONS
Age, ingestion of a strong acid, leucocytosis, deep gastric ulcers, and gastric necrosis are predictive of death after caustic ingestion. A risk score system including these predictors may be useful in prognostic evaluation.
Rigo
G P
GP
Gastrointestinal Unit, University of Modena and Reggio Emilia, Modena, Italy.
Camellini
L
L
Azzolini
F
F
Guazzetti
S
S
Bedogni
G
G
Merighi
A
A
Bellis
L
L
Scarcelli
A
A
Manenti
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002057:Burns, Chemical / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D002424:Caustics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004064:Digestive System / Q000293:injuries; D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013156:Splenectomy / Q000379:methods / Q000401:mortality; D018709:Statistics, Nonparametric; D015996:Survival Rate
D002424:Caustics