Risk factors for sepsis in patients with colorectal cancer complicated with gastrointestinal perforation and its impact on prognosis

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Prognostic Factors in Patients with Gastrointestinal Perforation under the Acute Care Surgery Model : A retrospective cohort study

“…2, with an AUC of 0.948, con rming their reliable predictive value. anemia [10,11], lactate levels [12], the psoas muscle index [13], age, SBP [14], and procalcitonin [15]. Separate from this, research on scoring systems has also been conducted, notably involving Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) system, SOFA scores, APACHE II scores, and Mannheim Peritonitis Index (MPI).…”

A Narrative Literature Review on Sepsis: A Primary Manifestation of Colorectal Neoplasm

“…Perforation of the digestive tract can lead to intra-abdominal infection, peritonitis, abscess formation, and the progression to sepsis and septic shock. The combination of CRC and gastrointestinal perforation has a poor prognosis, so a reliable model can help detect patients at high risk of developing sepsis [ 24 ]. Digestive tract tumors, including CRC, can contribute to developing anemia through multiple mechanisms.…”

“…This discrepancy may be attributed to the specific patient population included in the study. Overall, considering these factors and closely monitoring CRC patients is essential, particularly those with gastrointestinal perforation, to avoid the development of sepsis and prevent and treat infections promptly [ 24 ].…”