Risk Factors for Mortality in Patients With Strangulating Intestinal Obstruction Who Present With Septic Disseminated Intravascular Coagulation Prior to the Initiation of Treatment

TL;DR

This study identifies early warning signs that can predict death in patients with a severe intestinal emergency complicated by blood clotting issues.

Contribution

The study identifies low white blood cell count and high DIC scores after treatment as new independent predictors of mortality in this condition.

Findings

Low white blood cell count (<8,000/µL) on Day 1 after treatment is strongly linked to higher mortality.

High DIC scores (>4) on Day 1 are also independently associated with increased risk of death.

Early recognition of these factors could improve patient outcomes through timely intensive care escalation.

Abstract

Strangulating ileus is a life-threatening surgical emergency characterized by intestinal ischemia and necrosis due to impaired blood flow and is frequently complicated by septic disseminated intravascular coagulation (DIC). Despite surgical and intensive care management, prognosis remains extremely poor. Early identification of prognostic factors associated with mortality is therefore crucial. This study aimed to identify early predictors of poor prognosis in patients with strangulating ileus complicated by septic DIC.

We retrospectively analyzed 67 patients diagnosed with strangulating ileus at a single institution between 2020 and 2024, who subsequently developed septic DIC according to the Japanese Society for Emergency Medicine criteria and were treated with recombinant thrombomodulin (rTM). Patients with preoperative intestinal perforation, malignant tumors, or those receiving maintenance dialysis were excluded. Systemic inflammatory response syndrome (SIRS) score, Quick Sequential Organ Failure Assessment (qSOFA) score, Sequential Organ Failure Assessment (SOFA) score, DIC score, and white blood cell (WBC) count were evaluated preoperatively (Pre) and on the day after rTM administration (Day 1). Patients were divided into a survival group (S group) and a mortality group (M group), and variables were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors.

Among the 67 patients, 38 survived and 29 died. On Day 1, SIRS scores, qSOFA scores, SOFA scores, and DIC scores were all significantly higher in the mortality group than in the survival group (P < 0.05). Mortality was also significantly higher in patients with a Day 1 WBC count < 8,000/µL and those with a Day 1 DIC score > 4. Multivariate logistic regression analysis identified a Day 1 WBC count < 8,000/µL (odds ratio (OR), 19.8; 95% confidence interval (CI), 3.64–72.6; P = 0.012) and a Day 1 DIC score > 4 (OR, 1.75; 95% CI, 1.27–9.34; P = 0.04) as independent predictors of mortality.

In patients with strangulating ileus complicated by septic DIC, early leukopenia and persistently high DIC scores after rTM administration are independent poor prognostic factors. Early recognition of these indicators may allow prompt escalation of intensive care and contribute to improved outcomes in this highly lethal condition.