Analysis of the value of lactate dehydrogenase to albumin ratio as a predictor of early mortality in patients with sigmoid volvulus undergoing emergency surgery

Öz

Aim: Sigmoid volvulus represents an important cause of mechanical large-bowel obstruction and may rapidly progress to life-threatening complications, particularly in elderly or frail patients. This study evaluated whether the preoperative lactate dehydrogenase-to-albumin ratio (LAR) predicts early mortality after emergency surgery for sigmoid volvulus. Methods: The retrospective study included 62 patients who underwent emergency surgery for the treatment of sigmoid volvulus at two tertiary centers between January 2015 and June 2025. A time-dependent receiver operating characteristic (ROC) curve was used to identify the best preoperative LAR threshold; the selected cutoff was 8.84. Factors associated with early postoperative mortality were assessed using logistic regression models. Results: Among the 62 patients, the mean age was 61.7±15.1 years (range: 19-84), and 52 patients (83.8%) were men. Seven patients (11.29%) died in the early postoperative period. Urea and creatinine elevation, perforation, LAR ≥8.84, and operative time >120 min were significant in univariate analysis. In the multivariable model, LAR remained independently associated with early mortality (odds ratio, 19.024; 95% confidence interval, 1.6895-214.20; P=0.017). Conclusion: A higher preoperative LAR was independently linked to early postoperative death in patients who required emergency surgery for sigmoid volvulus.

Anahtar Kelimeler

• Sigmoid volvulus
• emergency surgery
• lactate dehydrogenase-to-albumin ratio
• mortality

Acil cerrahi uygulanan sigmoid volvulus hastalarında erken mortalitenin öngörücüsü olarak laktat dehidrojenaz/albümin oranının değerinin analizi

Öz

Amaç: Sigmoid volvulus, özellikle yaşlı hastalarda görülen, mekanik intestinal obstrüksiyonun yaygın bir nedenidir ve yüksek mortalite oranına sahip, yaşamı tehdit eden bir acil durumdur. Çalışmamızın amacı, sigmoid volvulus nedeniyle acil cerrahi uygulanan hastalarda erken mortalite açısından laktat dehidrogenaz/albümin oranının (LAR) rolünü araştırmaktır. Yöntemler: Bu retrospektif çalışmaya, Ocak 2015 ile Haziran 2025 tarihleri arasında iki üçüncü basamak merkezde sigmoid volvulus tedavisi için acil cerrahi uygulanan 62 hasta dahil edildi. Zaman bağımlı alıcı işletim karakteristiği (ROC) analizi sonucuna göre, preoperatif LAR için optimal kesim değeri 8.84 olarak belirlendi. Erken postoperatif mortaliteyi etkileyen prediktörleri değerlendirmek amacıyla lojistik regresyon analizleri kullanıldı. Bulgular: Sigmoid volvulus nedeniyle 62 hastaya acil cerrahi uygulandı; hastaların ortalama yaşı 61.7±15.1 (aralık: 19–84)olup, 52’si (%83.8) erkekti. Erken postoperatif mortalite 7 (%11.29) hastada gözlendi. Tek değişkenli analizde,yüksek üre-kreatinin düzeyleri, perforasyon varlığı, LAR ≥8.84 olması ve uzamış cerrahi süre (>120 dakika) erkenmortalitenin prediktörleri olarak saptandı. Çok değişkenli lojistik regresyon analizinde ise LAR’ın, sigmoid volvulusnedeniyle acil cerrahi uygulanan hastalarda erken mortalitenin bağımsız bir prediktörü olduğu gösterildi (olasılık oranı,19.024; %95 güven aralığı, 1.6895–214.20; p = 0.017). Sonuç: Çalışmamız, LAR’ın sigmoid volvulus nedeniyle acil cerrahi uygulanan hastalarda erken mortalite riskindeki artış ile bağımsız olarak ilişkili olduğunu ortaya koymuştur.

Anahtar Kelimeler

• Sigmoid volvulus
• acil cerrahi
• laktat dehidrogenaz/albümin oranı
• mortalite

Kaynakça

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