Clinical Manifestation and Risk Factors Related to The Severity of Corrosive Ingestion Patients: A Retrospective Study from Phrapokklao Hospital, Chanthaburi

Abstract

BACKGROUND: The ingestion of caustic substances can cause severe gastrointestinal injury. Accurate early assessment is essential for appropriate management and prognosis. The primary objective of this study was to identify the clinical factors associated with severe gastrointestinal injury in adult patients with caustic ingestion. Secondary objectives were to compare clinical outcomes and complications between severity groups, and to derive a preliminary exploratory prediction model and risk score from clinical data.

METHODS: A retrospective cohort study was conducted over 10 years and 6 months (January 2015–July 2025). Patients with caustic substance ingestion who underwent upper gastrointestinal endoscopy within 48 hours were included. Gastrointestinal injury was graded by Zargar classification and categorized as either non-severe (grades 0-2A) or severe (grades 2B-4). Chi-square test, Mann-Whitney U test, and Multiple logistic regression were used for analysis.

RESULTS: A total of 162 patients were included. Of these, 113 (69.8%) had non-severe injuries, and 49 (30.2%) had severe injuries. Multivariable logistic regression (four clinical variables entered simultaneously) identified three statistically significant independent predictors of severe gastrointestinal injury: age ≥ 65 years (aOR=12.17, 95% CI: 1.90-78.12, p=0.008), nausea and vomiting (aOR=3.88, 95% CI: 1.47–10.25, p=0.006), and ingestion volume≥100 mL (aOR=2.82, 95% CI: 1.26–6.35, p=0.012); respiratory symptoms did not remain significant after adjustment (aOR=3.75, 95% CI: 0.64–21.87, p=0.141). The full four-variable model showed acceptable discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.65–0.82). At the optimal cut-off value of 0.62, the model showed a sensitivity of 84.1% and a specificity of 53.1%. A post hoc exploratory 0-4 point risk score derived from the three significant predictors yielded an AUC of 0.72 (95%CI: 0.64-0.81); at a threshold of≥1 point, sensitivity was 89.8% and specificity was 32.7%.

CONCLUSIONS: Age≥65 years, nausea and vomiting, and ingestion volume≥100 mL were the three statistically significant independent predictors within a four-variable multivariable model (which also included respiratory symptoms) of severe gastrointestinal injury in patients with caustic ingestion. The model uses only clinical data history and physical examination without advanced investigations. Therefore, it may assist early risk stratification and prioritization of investigation in emergency settings and resource-limited hospitals.