Caustic ingestion: development and validation of a prognostic score

Abstract

Background Caustic ingestion is a potentially severe condition and early identification of poor outcome is essential to improve management; however, prediction based on endoscopy alone can overestimate severity. This study aimed to develop and validate a prognostic score.

Methods A prospective cohort study was designed to include all consecutive patients aged > 15 years who presented with caustic ingestion between 1995 and 2017. Adverse outcome was defined by intensive care unit admission, urgent surgery, or death. The predictive value of clinical, analytical, and endoscopic variables was assessed in the first cohort (derivation cohort) and a prognostic score based on the resulting risk factors was developed by logistic regression. Internal validation (bootstrapping) was performed and then external validation was checked in an independent sample of patients (validation cohort).

Results 469 cases of caustic ingestion were included, 265 in the derivation cohort and 204 in the validation cohort. Ingestion of acidic substances (odds ratio [OR] 3.13, 95 % confidence interval [CI] 2.33 – 4.21), neutrophil count (OR 1.05, 95 %CI 1.04 – 1.06), metabolic acidosis (bicarbonate value, OR 0.82, 95 %CI 0.78 – 0.85), and endoscopic injury (OR 3.81, 95 %CI 3.35 – 4.34) were independent risk factors for poor outcome. The prognostic score based on these variables provided better accuracy than endoscopy alone (P = 0.04), with high sensitivity, specificity, positive and negative predictive values (93.3 %, 92.7 %, 72.7 %, 98.5 %, respectively), and area under the curve (0.976, 95 %CI 0.973 – 0.979; P < 0.001).

Conclusions This score allowed a reliable prognosis of caustic ingestion and was more accurate than endoscopy-based evaluation.

Publikationsverlauf

Eingereicht: 18. Mai 2020

Angenommen: 23. Oktober 2020

Accepted Manuscript online:
23. Oktober 2020

Artikel online veröffentlicht:
18. Januar 2021

• References

• 1 Zargar SA, Kochhar R, Nagi B. et al. Ingestion of corrosive acids. Gastroenterology 1989; 97: 702-707
• 2 Zargar SA, Kochhar R, Nagi B. et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol 1992; 87: 337-341
• 3 Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary in all caustic ingestions?. J Pediatr Gastroenterol Nutr 2001; 32: 50-53
• 4 Gaudreault P, Parent M, Mcguigan MA. et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics 1983; 71: 767-770
• 5 Crain EF, Gershel JC, Mezey AP. Caustic ingestions: symptoms as predictors of esophageal injury. Am J Dis Child 1984; 138: 863-865
• 6 Previtera C, Giusti F, Guglielmi M. Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients?. Pediatr Emerg Care 1990; 6: 176-178
• 7 Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W. et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med 1992; 10: 189-194
• 8 De Jong AL, Macdonald R, Ein S. et al. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhinolaryngol 2001; 57: 203-211
• 9 Rigau J, Padrós J, Giménez-Roca A. et al. [Digestive lesions resulting from ingestion of caustic substances] [Article in Spanish]. Gastroenterol Hepatol 2001; 24: 319
• 10 Tseng Y-LL, Wu M-HH, Lin M-YY. et al. Outcome of acid ingestion related aspiration pneumonia. Eur J Cardiothoracic Surg 2002; 21: 638-643
• 11 Núñez Ó, González-Asanza C, de la Cruz G. et al. [Study of predictive factors of severe digestive lesions due to caustics ingestions] [Article in Spanish]. Med Clin (Barc) 2004; 123: 611-614
• 12 Havanond C, Havanond P. Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion. J Emerg Med 2007; 33: 349-353
• 13 Prieto P, Martín D, Grande A. et al. Caustic ingestion: a review of cases of a third level hospital [Article in Spanish]. Bol Pediatr 2007; 47: 55-61
• 14 Betalli P, Falchetti D, Giuliani S. et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc 2008; 68: 434-439
• 15 Zargar SA, Kochhar R, Mehta S. et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991; 37: 165-169
• 16 Tosca J. Caustic ingestion in adults: clinical outcome and determinant factors [Article in Spanish, Doctoral thesis]. Universitat de València; 2010
• 17 Moons KGM, Altman DG, Reitsma JB. et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162: W1-W73
• 18 Collins GS, Reitsma JB, Altman DG. et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Eur Urol 2015; 67: 1142-1151
• 19 Ryu HH, Jeung KW, Lee BK. et al. Caustic injury: can CT grading system enable prediction of esophageal stricture?. Clin Toxicol 2010; 48: 137-142
• 20 Chang J-M, Liu N-J, Pai BC-J. et al. The role of age in predicting the outcome of caustic ingestion in adults: a retrospective analysis. BMC Gastroenterol 2011; 11: 72
• 21 Cheng Y-J, Kao E-L. Arterial blood gas analysis in acute caustic ingestion injuries. Surg Today 2003; 33: 483-485
• 22 Kamijo Y, Kondo I, Kokuto M. et al. Miniprobe ultrasonography for determining prognosis in corrosive esophagitis. Am J Gastroenterol 2004; 99: 851-854
• 23 Chiu HM, Lin JT, Huang SP. et al. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc 2004; 60: 827-833
• 24 Chirica M, Resche-Rigon M, Pariente B. et al. Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy. Surg Endosc Other Interv Tech 2015; 29: 1452-1461
• 25 Chirica M, Resche-Rigon M, Zagdanski AM. et al. Computed tomography evaluation of esophagogastric necrosis after caustic ingestion. Ann Surg 2016; 264: 107-113
• 26 Mamede RC, de Mello Filho FV. Ingestion of caustic substances and its complications. Sao Paulo Med J 2001; 119: 10-15
• 27 Chang J-MM, Wu M-HH, Lai W-WW. et al. Acid corrosive injury in patients with a history of partial gastrectomy: outcome analysis. Dig Surg 2007; 24: 202-207
• 28 Hollenbach M, Tünnemann J, Struck M. et al. Endoscopic findings and outcome in caustic ingestion of acid and alkaline agents in adults. Endoscopy 2018; 50: S157
• 29 Santos S, Borges V, Simões G. et al. Caustic ingestion: predictors of clinical and endoscopic severity. Endoscopy 2019; 51: S170
• 30 García Díaz E, Castro Fernández M, Romero Gómez M. et al. Upper gastrointestinal tract injury caused by ingestion of caustic substances [Article in Spanish]. Gastroenterol Hepatol 2001; 24: 191-195
• 31 Rigo GP, Camellini L, Azzolini F. et al. What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?. Endoscopy 2002; 34: 304-310
• 32 Poley J-W, Steyerberg EW, Kuipers EJ. et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc 2004; 60: 372-377
• 33 Cheng H-T, Cheng C-L, Lin C-H. et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8: 31
• 34 Arévalo-Silva C, Eliashar R, Wohlgelernter J. et al. Ingestion of caustic substances: a 15-year experience. Laryngoscope 2006; 116: 1422-1426
• 35 Chirica M, Bonavina L, Kelly MD. et al. Caustic ingestion. Lancet 2016; 389: 2041-2052