Risk factors for poor prognosis in elderly patients with mechanical intestinal obstruction and predictive efficacy analy-sis

Wang Meng; Wang Li; Shao Yan; Wang Tingting

doi:10.3969/j.issn.1671-6450.2024.03.011

Abstract：Objective To screen the risk factors leading to poor prognosis of elderly patients with mechanical in-testinal obstruction,and to evaluate the efficacy of different risk factors in predicting the poor prognosis of patients.Meth-ods Retrospectively analyzed 98 cases of elderly patients with mechanical intestinal obstruction admitted to the Department of Gastrointestinal(Oncology)Surgery of the First Affiliated Hospital of Xinjiang Medical University from February 2021 to February 2023,which were divided into a good prognosis group(n=76)and a poor prognosis group(n=76)according to the prognosis of the patients.poor prognosis group(n=22).We compared the differences in clinical data,symptoms and signs,inflammation-related indexes,and treatment-related characteristics between the 2 groups;analyzed the correlation be-tween clinical data,symptoms and signs,inflammation-related indexes,and treatment-related characteristics of elderly pa-tients with mechanical intestinal obstruction and poor prognosis;and screened the risk factors for poor prognosis of elderly patients with mechanical intestinal obstruction by multifactorial logistic regression and evaluated their predictive efficacy by the subjects'work characterization curve(ROC).ROC)to evaluate their predictive efficacy.Results The mean BMI,PG-SGA grade and prevalence of diabetes mellitus in the poor prognosis group were statistically different from those in the good prognosis group(t/χ2/P=2.486/0.015,8.164/0.017,4.382/0.036);statistically significant differences in the proportion of patients in the poor prognosis group who experienced loss of bowel sounds and progressive exacerbation of abdominal pain com-pared with patients in the good prognosis group(χ2/P=4.025/0.045,4.248/0.039);prognostication The mean CRP,PCT,IL-6,and NLR levels of patients in the poor prognosis group were significantly higher than those of patients in the good progno-sis group(t/P=2.653/0.009,2.478/0.015,2.391/0.019,2.636/0.010);the difference between the average length of surgery,the proportion of glucocorticoid application and the average length of hospitalization of the patients in the poor prognosis group compared with the patients in the good prognosis group was statistically significant(t/χ2/P=2.373/0.020,5.002/0.025,2.366/0.020);Spearman's correlation analysis showed that PG-SGA classification,prevalence of diabetes mellitus,serum CRP,PCT,IL-6,and NLR levels in elderly patients with mechanical intestinal obstruction were significantly and positively correla-ted with poor prognosis(r/P=0.202/0.040,0.211/0.037,0.213/0.036,0.229/0.023,0.211/0.037,0.207/0.039),and the mean BMI level was significantly negatively correlated with poor prognosis(r=-0.242/0.016);multifactorial logistic regression analysis showed that lower BMI,higher PG-SGA grading,serum PCT,IL-6 and IL-2 levels in elderly patients with painful mechanical intestinal obstruction were all risk factors for poor prognosis[OR(95%CI)=0.377(0.196-0.724),9.893(5.087-16.043),2.835(1.742-10.840),1.415(1.044-1.919),2.990(1.905-9.884)];BMI,PCT,IL-6 and NLR levels predicted adverse prognosis in elderly patients with mechanical intestinal obstruction with AUCs of 0.668,0.659,0.646,and 0.630,respectively,and the differences in the predictive efficacy of each of the four individually were not statistically significant when compared by De-Long's method(Z=1.321,P=0.357).Conclusion Changes in BMI and serum PCT,IL-6 and NLR levels in elderly patients with mechanical intestinal obstruction are of great value in predicting poor prognosis,suggesting that nutritional status and inflammatory response level are related to the treatment effect of mechanical intestinal obstruction in elderly patients,and that changes in the above indexes should be closely monitored in clinical practice to assess the prognosis of the patients.