Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study

Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study Stephen Angira Khadolwa, Joshua Muhumuza, Demoz Abraha, Robert Masereka, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4020748/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction In Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus. Due to unavailability of endoscopic services in some settings, most of the patients usually undergo emergency surgery. The aim of this study was to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja, Hoima and Fortportal regional referral hospitals (FRRH, HRRH and FRRH respectively). Methods This was an observational prospective cohort done at 3 regional referral hospitals in Uganda. Patients undergoing surgery for sigmoid volvulus were enrolled consecutively and followed up till the time of discharge or death to document the mortality, occurrence of complications and length of hospital stay. Data analysis was done using SPSS version 26 with Poisson regression done to determine the factors. Results In this study that enrolled 81 participants, majority were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Hemodynamic instability was seen in 27(33.3%), non-viable gut in 27(33.3%) with colostomies placed in 61(75.3%) of the participants. Death occurred in 10(12.3%) of the patients, while 37(45.7%) had at least one complication with the commonest complication being surgical site infection 21(25.9%). The median length of hospital stay (LOS) was 8(IQR=7-11) days. At multivariate level of analysis, hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P<0.001) were independently associated with mortality, hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P<0.001) associated with occurrence of complications, while duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) were independently associated with prolonged hospital stay. Conclusion A big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn could improve the outcomes. sigmoid volvulus clinical profile adverse outcomes Uganda Background A closed loop of bowel that is vulnerable to strangling, ischemia, gangrene, and perforation results from sigmoid volvulus, which happens when the sigmoid colon bends axially around a small base of mesentery (1). Volvulus is frequently an emergency, and clinical and radiologic features help to determine its diagnosis (1). Constipation, stomach pain, nausea, vomiting, and distention are among the typical presenting symptoms (2). There may be symptoms of peritonitis (guarding and rebound tenderness) and bleeding per rectum, depending on how long the condition has been present. Traditionally, asymmetric gaseous abdominal distention and emptiness of the left iliac fossa serve as the pathognomonic signs of sigmoid volvulus (3). The optimum therapeutic approach for treating volvulus is still up for debate and depends on the surgery selected, the patient's clinical state, the location of the problem, the possibility or confirmation of peritonitis, the viability of the intestine, and the surgical team's experience (1). Patients should undergo urgent surgery if they have signs of intestinal perforation or ischemia when they first arrive (4). In the absence of peritonitis, flexible sigmoidoscopy, which has an 80% success rate for colonic detorsion and decompression, is the first-line treatment of choice for sigmoid volvulus (4). Elective sigmoid colectomy is the recommended course of treatment for instances of simple volvulus following detorsion. Due to their high failure rates, nonoperative treatment and non-resectional surgery, such as sigmoidopexy should only be used in weak patients who are unsuited for colectomy (5). In Western nations, sigmoid volvulus causes 2-5% of intestinal blockage (6). The incidence of sigmoid volvulus has been reported to be high in South America, Africa, Eastern Europe, Scandinavia, Russia, the Middle East, Pakistan, and India (7). The anatomical, cultural, and nutritional variations may all contribute to this geographic diversity (8). In the developing world, 50% of major bowel blockages are caused by sigmoid volvulus (9). High-fiber diets and pre-existing redundant sigmoid colon have been cited as key factors in the multifactorial aetiology of this condition (10). One of the staple foods in Uganda that has been connected to the aetiology of sigmoid volvulus is cassava, which has also been associated to rice, millet, porridge, peas, soya, beans, oranges, and mangoes (11). A shorter intestinal transit time brought on by this high-fiber diet is hypothesized to result in a redundant sigmoid colon (10). In Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus (12) and can be a life-threatening emergency (13) given that it is the most frequent reason for colon strangulation (1). Due to unavailability of endoscopic services in some settings, most of the patients usually undergo surgery unless there is spontaneous resolution (10). Whereas clinical patterns of presentation may influence the type of surgery and the surgery's results, nothing is known about these patterns in our setting. More so, though there are some studies which have assessed sigmoid volvulus in northern Uganda and the central region, there is paucity of data on some aspects like length of hospital stay, clinical patterns and exhaustive assessment of the factors. The only study that assessed factors in northern Uganda, was a retrospective review of one hospital record which yielded low quality evidence (10). There is need to have high quality evidence from the different regions of Uganda on clinical profiles, outcomes and factors associated with outcomes; the reason this multicenter prospective study was done. This study aimed to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja Regional Referral Hospital (JRRH), Hoima Regional Referral Hospital (HRRH) and Fortportal Regional Referral Hospital (FRRH). The clinical profile included the hemodynamic status at presentation, gut viability and type of surgical intervention done. The early outcomes was defined by death, complications and length of hospital stay. The factors assessed included both social demographic and clinical factors. Methods Study design and period This was a multicentre prospective cohort done in the surgery departments of three regional referral hospitals; specifically Hoima, Jinja, and Fortportal, over a period of 5 months. Study setting The 3 hospitals are located in 3 different regions of Uganda and each hospital has general surgeons and senior house officers in the surgery departments. These doctors are responsible for the care of the patients with sigmoid volvulus. On average, each hospital receives 8 patients with sigmoid volvulus per month. Study population All patients above the age of 18 years who underwent surgery for sigmoid volvulus at the selected study centres during the study period were included in the study if they consented. Sample size and sampling The sample size was determined using Daniel’s formula. Using the findings by Chalya & Mabula (14) in Tanzania where sigmoid volvulus accounted for 14.2% of the patients with intestinal obstruction, P=0.142, Where Z = 1.96, q = 1-p (85.8%) and e = 0.05. On substitution, n 0 = 187.2. Adjusting to a finite population of 120, using the formula , n’=73.3. Adding 10% for those lost during follow up, 81 participants were needed. Since the approximate number of patients with sigmoid volvulus seen at these hospitals was approximately equal, 1/3 of the sample size was taken from each study centre (27 participants from each centre). Consecutive sampling was done till the sample size was reached. Recruitment and data collection procedure Informed consent was obtained for legible participants. At admission, the vital signs were taken and the rest of social demographic and clinical information recorded. Resuscitation with fluids and electrolytes was done for all in accordance to the hemodynamic status at admission and the laboratory findings. Nasogastric tube and Foley catheter were inserted. A blood sample for serum electrolytes and complete blood count were taken. Antibiotics (ceftriaxone and metronidazole) were administered (15). At surgery the gut viability was assessed and the type of surgery done noted. The patients were followed up till discharge to asses for early outcomes specifically morbidity (surgical site infection, burst abdomen and anastomotic leakage), length of hospital stays and mortality. Patients who were still admitted on the 30 th day were considered to have been hospitalized for more than 30 days and considered not to have died. Study variables The dependent variables were early adverse outcome including complications (wound sepsis, wound dehiscence, anastomotic leak and others), prolonged hospital stay and mortality. Independent variables included social-demographics like (age, sex, residence and smoking) and clinical factors like (Vital signs and gut viability and laboratory findings). The intervening variable was the type of surgery: Sigmoidectomy + Primary anastomosis, or Hartmans procedure. Quality control The data collection tool was pretested for validity and reliability and adjustments made before starting data collection. The research protocol was explained to the research assistants during training. Every day, the principal investigator or his assistant double-checked the data to make sure it was accurate. A general surgeon supervised the research and all procedures were done by a qualified surgeon or a senior house officer under supervision of a general surgeon. Data analysis Microsoft office excel was used to summarize data and then analysis was done by using SPSS version 26.0. Frequencies and percentages were used for the different elements of the clinical profile and early outcomes. For length of hospital stay, the median was reported since the length of stay was not normally distributed. Bivariate and multivariate analysis was done. Variables with P<0.2 were analysed at multivariate level. P values, risk ratios and confidence intervals obtained using Poisson regression were reported in tables with p<0.05 considered significant .This procedure was done for factors associated with mortality, occurrence of complications and prolonged hospital stay in order to report the specific factors for each of the 3 outcome categories. Ethical considerations and consent: All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was granted by the Research and Ethics Committee of Mulago hospital (Ref No: MHREC 2538 ). All participants gave written informed consent . Results In this study that enrolled 81 participants that underwent surgery for sigmoid volvulus, majority of the study participants were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Majority were from rural areas 58(71.6%) and only 17(21.0%) reported a history of smoking (Table 1). Table 1: Baseline social demographic characteristics of study participants Characteristic Frequency Percentage Age (Years) Mean=55.1, SD=14.2, Min=29, max=81 29-45 (Middle aged adults) 22 27.2 46 - 65 (Older adults) 36 44.4 66-81(Elderly) 23 28.4 Sex Male 63 77.8 Female 18 22.2 Education None 6 7.4 Primary 30 37.0 Secondary 24 29.6 Tertiary 21 25.9 Religion Christian 61 75.3 Muslim 20 24.7 Residence Rural 58 71.6 Urban 23 28.4 Smoking No 64 79.0 Yes 17 21.0 Of the 81 study participants, 27(33.3%) had both a low systolic blood pressure and a high pulse rate and therefore classified as hemodynamically unstable. Non-viable gut was found in 27(33.3%) of the participants. Fifteen (18.5%) of the patients had a bowel perforation. Majority of the patients had a colostomy placed 61(75.3%) either due to the condition of the gut or the hemodynamic status (Table 2). Table 2: Clinical profile of patients undergoing surgery for sigmoid volvulus at JRRH, HRRH and FRRH . Characteristic Frequency Percentage Hemodynamic stability Stable 54 66.7 Un stable (PR>100, SBP<90) 27 33.3 Gut Viability Viable 54 66.7 Non-viable 27 33.3 Bowel perforation No 66 81.5 Yes 15 18.5 Bowel procedure done Primary anastomosis 20 24.7 Colostomy 61 75.3 PR=Pulse rate, SBP=Systolic blood pressure. In this study, 10 of the patients died representing a mortality of 12.3%. Thirty seven (45.7%) of the participants had at least one complication with the commonest complication being surgical site infection seen in 21(25.9%) of the study participants. The median length of hospital stay was 8(IQR=7-11) days with 40(49.4) of the patients staying in hospital for a duration above the median (>8 days) (Table 3). Table 3: Early outcomes of surgery among patients with sigmoid volvulus at JRRH, HRRH and FRRH . Outcome Frequency Percentage Mortality No 71 87.7 Yes 10 12.3 Complications No complication 44 54.3 One or more complications 37 45.7 Surgical site infection 21 25.9 Burst abdomen 3 3.7 Leakage 2 2.5 Superficial wound dehiscence 9 11.1 Other complication (DVT=3, respiratory complications=5) 8 9.9 Length of stay (Days) Median=8, IQR= 7-11, Min=3, Max=18 ≤ Median (8) 41 50.6 > median 40 49.4 IQR= Interquartile range, Hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P<0.001) independently predicted mortality in multivariate analysis. The risk of mortality was increased by 2.210 times among patients that had hyperkalemia, while it was increased by 1.913 times among patients that had a sigmoid perforation (Table 4). Detailed bivariate analysis is shown in supplementary file 1 as table S1. Table 4: Multivariate analysis of factors associated with Mortality . Characteristic Bivariate analysis Multivariate analysis cRR 95% CI P value aRR 95% CI P value Sex Male Ref Female 2.714 0.674-10.938 0.160 1.014 0.674-6.938 0.321 Residence Rural 4.041 0.482-33.879 0.198 2.041 0.652-11.879 0.693 Urban Ref Diabetes No Ref Yes 3.918 0.822-18.674 0.086 2.918 0.672-8.674 0.481 Symptom duration ≤3 (Median) Ref 4+ 2.184 1.352-6.724 0.024 1.134 0.512-7.324 0.121 Anemia No Ref Yes 2.452 1.464-8.435 0.014 1.312 0.464-5.035 0.116 Sodium Normal Ref Low 1.706 0.850-5.921 0.071 1.306 0.850-6.921 0.271 High 2.667 1.485-8.023 0.020 1.157 0.485-6.023 0.120 Potassium Normal Ref Low 1.857 1.305-4.307 0.024 2.0547 0.557-7.578 0.101 High 2.684 1.913-9.426 0.005 2.210 1.512-3.630 0.024 Perforation No Ref Yes 3.600 5.421-28.250 <0.001 1.913 1.015-3.962 <0.001 more likely to have blood culture positive sepsiss (aOR=red patient who had a d the symptoms was A history of hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P<0.001) independently predicted occurrence of complications in multivariate analysis. The risk of complications was increased by 2.726 times in hypertensive patients while it was increased by 2.500 times among patients that had hemodynamic instability (Table 5). Detailed bivariate analysis is shown in supplementary file 1 as table S2. Table 5: Multivariate analysis of factors associated with occurrence of complications . Characteristic Bivariate analysis Multivariate analysis cRR 95% CI P value aRR 95% CI P value Age 29-45 (Middle aged adults) Ref 46 - 65 (Older adults) 1.400 0.471-4.161 0.545 0.112 0.011-1.174 0.068 66+(Elderly) 2.275 0.687-7.535 0.179 0.141 0.007-3.033 0.211 Hypertension No Ref Yes 2.932 1.183-7.267 0.020 2.726 1.206-6.158 0.016 Instability No Ref Yes 2.625 1.661-4.149 <0.001 2.500 1.561-4.004 <0.001 Symptom duration ≤3 (Median) Ref 4+ 2.567 1.045-6.306 0.040 5.129 0.909-28.938 0.064 Anemia No Ref Yes 1.821 0.736-4.506 0.194 1.621 0.341-7.714 0.544 Sodium Normal Ref Low 1.942 0.760-4.966 0.166 0.686 0.178-2.645 0.584 High 0.767 0.166-3.544 0.734 0.121 0.010-1.437 0.094 Perforation No Ref Yes 4.231 1.217-14.713 0.023 1.133 0.150-8.546 0.904 Procedure Anastomosis Ref Colostomy 2.411 0.819-7.101 0.110 1.042 0.261-4.160 0.953 more likely to have blood culture positive sepsiss (aOR=red patient who had a d the symptoms was Duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and having hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) independently predicted prolonged hospital stay in multivariate analysis. A patient who presented after 3 days of symptoms was 1.217 times more likely to have prolonged hospital stay, while one who had hemodynamic instability was 1.165 times more likely to have prolonged hospital stay (Table 6). Detailed bivariate analysis is shown in supplementary file 1 as table S3. Table 6: Multivariate analysis of factors associated with prolonged hospital stay. Characteristic Bivariate analysis Multivariate analysis cRR 95% CI P value aRR 95% CI P value Age 29-45 (Middle aged adults) Ref 46 - 65 (Older adults) 1.917 0.632-5.820 0.251 0.382 0.046-3.185 0.374 66+(Elderly) 4.898 1.386-17.310 0.014 1.102 0.071-17.203 0.945 Residence Rural 3.017 1.078-8.443 0.035 0.946 0.797-1.122 0.521 Urban Ref Hypertension No Ref Yes 2.118 0.873-5.140 0.097 1.013 0.833-1.231 0.899 Diabetes No Ref Yes 2.687 0.643-11.235 0.176 1.064 0.882-1.284 0.518 HIV No Ref Yes 3.677 0.916-14.765 0.066 1.102 0.949-1.280 0.203 Instability No Ref Yes 4.857 1.747-13.506 0.002 1.165 1.017-1.335 0.028 Symptom duration ≤3 (Median) Ref 4+ 1.358 1.190-1.550 <0.001 1.217 1.016-1.458 0.033 R/tenderness No Ref Yes 1.929 0.788-4.719 0.150 0.995 0.825-1.200 0.961 Sodium Normal Ref Low 4.021 1.505-10.741 0.006 1.455 0.306-6.922 0.637 High 1.538 0.352-6.730 0.567 0.111 0.004-2.886 0.186 Perforation No Ref Yes 1.325 1.169-1.501 <0.001 5.346 0.572-49.948 0.142 Viability Viable Ref Non-viable 2.909 1.106-7.650 0.030 1.911 0.429-8.505 0.395 Procedure Anastomosis Ref Colostomy 4.038 1.302-12.529 0.016 1.726 0.373-7.985 0.485 Discussion Clinical profile. This study enrolled 81 participants that underwent surgery for sigmoid volvulus, majority of whom were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. This is because sigmoid volvulus is known to be common among males in the older age groups (40-50) years in third world countries (16). Majority were from rural areas 58(71.6%) probably due to the catchment area of the hospitals being rural settings. We noted that 27(33.3%) of the study participants had both a low systolic blood pressure and a high pulse rate and therefore classified as hemodynamically unstable. This percentage was higher than that reported in Turkey where hemodynamic instability was seen among 102 (24.3%) of the patients presenting with sigmoid volvulus (17). The difference could be because in this study a big number of patients had bowel gangrene or sigmoid perforation which both worsen the condition of the patient resulting in hypotension and tachycardia which constituted hemodynamic instability in this study. Non-viable gut was found in 27(33.3%) of the participants while 15 (18.5%) of the patients had a bowel perforation. Percentage of non-viable gut in this study was higher than that reported by Mulugeta & Awlachew (18) in Ethiopia where 26% had non-viable bowel but was lower than the percentage reported by Selçuk Atamanalp (17) in Turkey (63.1%) and Emna (19) in Tunisia (40%). The high percentage of non-viable bowel seen in our study is mainly because of delayed presentation where 46.9% of the study participants presented after 3 days of symptoms. Delay was probably due to inaccessibility of hospital from the rural areas. Majority of the patients had a colostomy placed 61(75.3%) either due to the condition of the gut or the hemodynamic status. This percentage was comparable to the one reported by Lee (20) in Korea (74.3%) but higher than that reported by Chalya & Mabula (14) in Tanzania and Okello (21) in Uganda at Mulago national referral hospital. The studies in Tanzania and Mulago had both emergency procedures and some elective procedure in which the volvulus was de-rotated endoscopically and then surgery done later. All the patients operated in our study underwent an emergency laparotomy and this could explain the difference in percentage of patients that had a stoma placed since emergency surgery increases possibility of stoma placement (22). The other explanations for having a big number of patients undergoing stoma placement could be because of the significant number of patients with bowel gangrene, hemodynamic instability and perforation with gross contamination which conditions increase the risk for anastomotic leakage making stoma placement the safer option. Early outcomes . In this study, 10 of the patients died representing a mortality of 12.3%. Our findings were in agreement with findings of a systematic review by Selvaraj & Palaniswamy (23) who reported that mortality following sigmoid volvulus ranged from 10-50%. Also the mortality found in this study was comparable though slightly lower than that reported in Mulago (15.9%) (21) and Tanzania (17%) (14). The mortality we found was higher than that reported by Awedew (24) in Ethiopia (6.45%), Jumbi & Kuremu (25) in Kenya (3.3%) and Wismayer (10) in northern Uganda (7.7%). The differences seen in mortality could be because these studies that reported lower mortality had some patients operated electively after derotation yet in our study there were no facilities for endoscopic derotation, yet emergency procedures are associated with a higher mortality (15). Also the high percentage of patients with perforated sigmoid (18.5%) could have contributed to the high mortality. Thirty seven (45.7%) of the participants had at least one complication with the commonest complication being surgical site infection seen in 21(25.9%) of the study participants. The percentage of patients with complications was comparable to that reported by Lee (20) where 40.0% of the patients that had emergency surgery for sigmoid volvulus got complications. Also our findings were in agreement with studies by Emna (19) in Tunisia, Mulugeta & Awlachew (18) in Ethiopia, Chalya & Mabula (14) in Tanzania and Wismayer (10) in northern Uganda who reported surgical site infection as the commonest complication. This is possibly because these surgeries would be classified as contaminated or even dirty if there is perforation which classifications are associated with a high risk of surgical site infection. The percentage of complications reported in our study was higher than that reported by Jumbi & Kuremu (25) in Kenya (21.7%), Chalya & Mabula (14) in Tanzania (20.5%) and Wismayer (10) in northern Uganda (17.5%). The high percentage of complications in this study could be attribute to the fact that a high percentage of the patients had perforated sigmoid (18.5%) which resulted in peritonitis. Given that surgical site infection was the commonest complication, the peritonitis could partly explain the high percentage of complications. The occurrence of sigmoid perforation can again be attributed to late presentation seen among most of the patients in our study since the median duration of symptoms at presentation was 3 days. The median length of hospital stay was 8(IQR=7-11) days with 40(49.4) of the patients staying in hospital for a duration above the median (>8 days). This LOS was comparable to that reported by Awedew (24) in Ethiopia (median=8 days) but slightly lower than that reported by Lee (20) in Korea (Median =11 days), Jumbi & Kuremu (25) in Kenya (average 11.8 days) and Chalya & Mabula (14) in Tanzania (Median=14 days). The High length of hospital stay could be attributed to the high occurrence of complications which are known to increase length of hospital stay. Factors associated with early adverse outcomes. The variables that were independently and significantly associated with mortality were hyperkalemia and presence of a sigmoid perforation. Our findings were in agreement with what was reported by Lee (20) in Korea who noted that mortality was significantly associated with presence of sigmoid colon gangrene or perforation (P=0.001), Chalya & Mabula (14) in Tanzania who reported that bowel gangrene or perforation predicted adverse outcomes and Wismayer (10) in northern Uganda who reported that electrolyte imbalances were associated with unfavourable outcomes. Presence of hyperkalemia may be an indicator of acute kidney injury which has a potential to increase mortality while sigmoid perforation results in generalized peritonitis which significantly increases mortality. The variables that were independently and significantly associated with occurrence of complications were a history of hypertension and presence of hemodynamic instability. Our findings are in agreement with what was reported by Lee (20) in Korea who noted that patients who had a concomitant disease like hypertension (P=0.001) and those who had hemodynamic instability or shock (P=0.001) had an increased risk of getting complications (20). Also in agreement are the findings by Okello (21) at mulago who reported that patients who had comorbid diseases like, hypertension had increased risk (21). Hemodynamic instability increases the risk of complications since it impairs healing and hence increasing risk of wound complications and even anastomotic leakage. Presence of hypertension more so if poorly controlled impairs perfusion of the tissues due to the associated arteriosclerosis impairing the healing of tissues and hence the occurrence of wound complications. The variables that were independently and significantly associated with prolonged hospital stay were duration of symptoms greater than 3 days and having hemodynamic instability. Though many studies have reported about length of stay among patients undergoing sigmoid volvulus surgery, this is the first study that has reported on the factors associated with length of stay following surgery for sigmoid volvulus to best of our knowledge. Delayed presentation increases the risk of bowel ischemia, gangrene and perforation. These in turn increase the risk of post-operative complications as was reported by Chalya & Mabula (14), which complications eventually results in prolonged hospital stay. The presence of hemodynamic instability also results in complications which in turn increase the length of hospital stay. Strength and limitations of the study This was a multicentre prospective cohort study that increases the generalizability of the findings. However, our findings are limited by the fact that the centres did not have endoscopic services which can be used to de-rotate volvulus and do the surgeries electively; which procedure has been associated with a better outcome. Therefore our finding may not be generalizable to the centres where endoscopic derotation is practiced. Conclusion and recommendations A big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. Hyperkalemia and presence of a sigmoid perforation independently predicted mortality. Hypertension and presence of hemodynamic instability predicted occurrence of complications. Duration of symptoms greater than 3 days and hemodynamic instability independently predicted prolonged hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn will improve the outcomes. All hospitals should be equipped with colonoscopy towers to enable derotation of some of the patients with sigmoid volvulus in whom derotation is indicated. Another multicentre prospective cohort should be done in hospitals that are able to do endoscopic derotation to assess the outcomes. Abbreviations cRR=Crude risk ratio, aRR=Adjusted risk ratio, CI=Confidence interval. Declarations Ethical considerations and consent: All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was granted by the Research and Ethics Committee of Mulago hospital ( MHREC 2538 ). All participants gave written informed consent. Consent for publication: Not applicable Availability of data and materials: Data is available upon request upon request from the corresponding author. Competing interests : The authors declare that they have no conflict of interest Sources of funding : This study did not receive any specific grant from funding agencies in public, commercial, or not for profit sectors. Author contribution: S.A.K. was the Principal investigator, conceived and designed the study, collected data, analysed data and wrote the draft of the manuscript. J.M. participated in data analysis, discussion of results and revised the manuscript. D.A. and R.M. supervised the work and revised the manuscript. M.D.O., U.K., J.I.K. and R.C.B. participated in data collection, revised the manuscript and all authors approved the final paper. Acknowledgements: We acknowledge all study participants. References Sarfaraz M, Hasan SR, Lateef S. Sigmoid volvulus in young patients: A new twist on an old diagnosis. 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Raveenthiran V, Madiba T, Atamanalp S, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12:e1–17. Toh JWT, Collins GP, Ridley LJ, Chan M, Schofield R. A tale of two twists: mesentero‐axial and organo‐axial sigmoid volvulus. Journal of Medical Imaging and Radiation Oncology. 2022 Jun 30; Ali M, Hashmi Z, Zafar A. Management of acute sigmoid volvulus, using one stage resection and anastomosis, without colonic lavage.. J Med Sci. 2009;7(2):101–4. Wismayer R. Incidence and Factors Influencing the Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study. In: Highlights on Medicine and Medical Science Vol 5. 2021. p. 8–34. Tumusiime G, Kakande I, Masira N. Factors associated with redundant sigmoid colon at Mulago Hospital, Kampala. East Centr Afr J Surg. 2009;14:65–8. Okeny PK, Hwang TG, Ogwang DM. Acute Bowel Obstruction in a Rural Hospital in Northern in Northern Uganda. East Cent Afr j surg. 2011;V(1). Saba M, Rosenberg J, Wu G, Hinika G. A case of sigmoid volvulus in an unexpected demographic. Surgical Case Reports. 2021;7(1):3–7. Chalya PL, Mabula JB. Sigmoid volvulus and ileo-sigmoid knotting: A five-year experience at a tertiary care hospital in Tanzania. World Journal of Emergency Surgery. 2015;10(1):4–11. Kazem shahmoradi M, khoshdani farahani P, Sharifian M. Evaluating outcomes of primary anastomosis versus Hartmann’s procedure in sigmoid volvulus: A retrospective-cohort study. Annals of Medicine and Surgery. 2021;62(January):160–3. David N, Bimston M, Steven J, Stryker M. Volvlus of the colon. Second. Current therapy in colon and rectal surgery. 2005. 557–612 p. Atamanalp SS, Aydinli B, Öztürk G, Başoǧlu M, Yildirgan MI, Ören D, et al. Classification of sigmoid volvulus. Turkish Journal of Medical Sciences. 2008;38(5):425–9. Mulugeta GA, Awlachew S. Retrospective study on pattern and outcome of management of sigmoid volvulus at district hospital in Ethiopia. BMC Surgery. 2019;19(1):1–5. Emna T, Atef M, Sarra S. Management of acute sigmoid volvulus: A Tunisian experience. Asian Journal of Surgery. 2022;45(1):148–53. Lee K, Oh HK, Cho JR, Kim M, Kim DW, Kang SB, et al. Surgical management of sigmoid volvulus: A multicenter observational study. Annals of Coloproctology. 2020;36(6):403–8. Okello T, Ogwang D, Kisa P, Komagum P. Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda. T.R. Okello , D.M. Ogwang, P. Kisa, P. Komagum. St. Mary’s Hospital Lacor, Gulu, Northern Uganda. East Cent Afr j surg (Online) ISSN 2073-9990. 2009;14(2):58–64. Kim EM, Kang BM, Kim BC, Kim JY, Park JH, Oh BY, et al. Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea. International Journal of Colorectal Disease. 2020;35(10):1841–7. Selvaraj DR, Palaniswamy C. Sigmoid volvulus. Journal of Hospital Medicine. 2010;5(4):9–11. Awedew AF. Magnitude and Clinical characteristics of Sigmoid Volvulus. Reserch squire. 2020;1–10. Jumbi G, Kuremu RT. Emergency resection of sigmoid volvulus. East African Medical Journal. 2008;85(8):398–405. Additional Declarations No competing interests reported. Supplementary Files TableS1BivariateanalysisoffactorsassociatedwithMortality..docx TableS2Bivariateanalysisoffactorsassociatedwithoccurrenceofcomplications..docx TableS3Bivariateanalysisoffactorsassociatedwithprolongedhospitalstay.docx Supplementaryfile.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4020748","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278266368,"identity":"31dadefb-6e99-415e-8c22-678913af791a","order_by":0,"name":"Stephen Angira 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University","correspondingAuthor":false,"prefix":"","firstName":"Rodrigue","middleName":"Cikuru","lastName":"Bukhendwa","suffix":""}],"badges":[],"createdAt":"2024-03-06 11:48:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4020748/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4020748/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59711186,"identity":"b90f512b-fab5-4475-90dc-08a5e6597798","added_by":"auto","created_at":"2024-07-05 07:18:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1355413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4020748/v1/653d58d9-c8e9-4816-baf6-aa30cbeeab48.pdf"},{"id":52522732,"identity":"68da7bb1-d468-4af4-b280-df72bcacc696","added_by":"auto","created_at":"2024-03-12 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15:04:39","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":43269,"visible":true,"origin":"","legend":"","description":"","filename":"TableS3Bivariateanalysisoffactorsassociatedwithprolongedhospitalstay.docx","url":"https://assets-eu.researchsquare.com/files/rs-4020748/v1/3fe5cc28bc2a076d612931ca.docx"},{"id":52522735,"identity":"23791412-3d59-40c1-90f0-f8ac74395476","added_by":"auto","created_at":"2024-03-12 15:04:39","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":74298,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-4020748/v1/dad254df7e335e226b199550.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study","fulltext":[{"header":"Background","content":"\u003cp\u003eA closed loop of bowel that is vulnerable to strangling, ischemia, gangrene, and perforation results from sigmoid volvulus, which happens when the sigmoid colon bends axially around a small base of mesentery (1).\u0026nbsp;Volvulus is frequently an emergency, and clinical and radiologic features help to determine its diagnosis (1).\u0026nbsp;Constipation, stomach pain, nausea, vomiting, and distention are among the typical presenting symptoms (2).\u0026nbsp;There may be symptoms of peritonitis (guarding and rebound tenderness) and bleeding per rectum, depending on how long the condition has been present. Traditionally, asymmetric gaseous abdominal distention and emptiness of the left iliac fossa serve as the pathognomonic signs of sigmoid volvulus (3).\u003c/p\u003e\n\u003cp\u003eThe optimum therapeutic approach for treating volvulus is still up for debate and depends on the surgery selected, the patient\u0026apos;s clinical state, the location of the problem, the possibility or confirmation of peritonitis, the viability of the intestine, and the surgical team\u0026apos;s experience (1).\u0026nbsp;Patients should undergo urgent surgery if they have signs of intestinal perforation or ischemia when they first arrive (4).\u0026nbsp;In the absence of peritonitis, flexible sigmoidoscopy, which has an 80% success rate for colonic detorsion and decompression, is the first-line treatment of choice for sigmoid volvulus (4).\u0026nbsp;Elective sigmoid colectomy is the recommended course of treatment for instances of simple volvulus following detorsion. Due to their high failure rates, nonoperative treatment and non-resectional surgery, such as sigmoidopexy should only be used in weak patients who are unsuited for colectomy (5).\u003c/p\u003e\n\u003cp\u003eIn Western nations, sigmoid volvulus causes 2-5% of intestinal blockage (6).\u0026nbsp;The incidence of sigmoid volvulus has been reported to be high in South America, Africa, Eastern Europe, Scandinavia, Russia, the Middle East, Pakistan, and India (7).\u0026nbsp;The anatomical, cultural, and nutritional variations may all contribute to this geographic diversity (8).\u0026nbsp;In the developing world, 50% of major bowel blockages are caused by sigmoid volvulus (9).\u0026nbsp;High-fiber diets and pre-existing redundant sigmoid colon have been cited as key factors in the multifactorial aetiology of this condition (10).\u0026nbsp;One of the staple foods in Uganda that has been connected to the aetiology of sigmoid volvulus is cassava, which has also been associated to rice, millet, porridge, peas, soya, beans, oranges, and mangoes (11).\u0026nbsp;A shorter intestinal transit time brought on by this high-fiber diet is hypothesized to result in a redundant sigmoid colon (10).\u003c/p\u003e\n\u003cp\u003eIn Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus (12)\u0026nbsp;and can be a life-threatening emergency (13)\u0026nbsp;given that it is the most frequent reason for colon strangulation (1).\u0026nbsp;Due to unavailability of endoscopic services in some settings, most of the patients usually undergo surgery unless there is spontaneous resolution (10).\u0026nbsp;Whereas clinical patterns of presentation may influence the type of surgery and the surgery\u0026apos;s results, nothing is known about these patterns in our setting.\u003c/p\u003e\n\u003cp\u003eMore so, though there are some studies which have assessed sigmoid volvulus in northern Uganda and the central region, there is paucity of data on some aspects like length of hospital stay, clinical patterns and exhaustive assessment of the factors. The only study that assessed factors in northern Uganda, was a retrospective review of one hospital record which yielded low quality evidence (10). There is need to have high quality evidence from the different regions of Uganda on clinical profiles, outcomes and factors associated with outcomes; the reason this multicenter prospective study was done. This study aimed to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja Regional Referral Hospital (JRRH), Hoima Regional Referral Hospital (HRRH) and Fortportal Regional Referral Hospital (FRRH). The clinical profile included the hemodynamic status at presentation, gut viability and type of surgical intervention done. The early outcomes was defined by death, complications and length of hospital stay. The factors assessed included both social demographic and clinical factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u0026nbsp;and period\u003c/h2\u003e\n\u003cp\u003eThis was a multicentre prospective cohort done in the surgery departments of three regional referral hospitals; specifically Hoima, Jinja, and Fortportal, over a period of 5 months.\u003c/p\u003e\n\u003ch2\u003eStudy setting\u003c/h2\u003e\n\u003cp\u003eThe 3 hospitals are located in 3 different regions of Uganda and each hospital has general surgeons and senior house officers in the surgery departments. These doctors are responsible for the care of the patients with sigmoid volvulus. On average, each hospital receives 8 patients with sigmoid volvulus per month.\u003c/p\u003e\n\u003ch2\u003eStudy population\u003c/h2\u003e\n\u003cp\u003eAll patients above the age of 18 years who underwent surgery for sigmoid volvulus\u0026nbsp;at the selected study centres during the study period were included in the study if they consented.\u003c/p\u003e\n\u003ch2\u003eSample size and sampling\u003c/h2\u003e\n\u003cp\u003eThe sample size was determined using Daniel\u0026rsquo;s formula. \u003cimg src=\"data:image/png;base64,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\" style=\"width: 100px; height: 31.7073px;\" width=\"100\" height=\"31.7073\"\u003e Using the findings by Chalya \u0026amp; Mabula (14) in Tanzania where sigmoid volvulus accounted for 14.2% of the patients with intestinal obstruction, P=0.142,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWhere\u0026nbsp;Z = 1.96, q = 1-p (85.8%) and e = 0.05. On substitution, n\u003csub\u003e0\u003c/sub\u003e= 187.2. Adjusting to a finite population of 120, using the formula \u003cimg src=\"data:image/png;base64,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\" style=\"width: 105px; height: 40.2336px;\" width=\"105\" height=\"40.2336\"\u003e, n\u0026rsquo;=73.3. Adding 10% for those lost during follow up, 81 participants were needed. Since the approximate number of patients with sigmoid volvulus seen at these hospitals was approximately equal, 1/3 of the sample size was taken from each study centre (27 participants from each centre). Consecutive sampling was done till the sample size was reached.\u003c/p\u003e\n\u003ch2\u003eRecruitment and data collection procedure\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained for legible participants. At admission, the vital signs were taken and the rest of social demographic and clinical information recorded. Resuscitation with fluids and electrolytes was done for all in accordance to the hemodynamic status at admission and the laboratory findings. Nasogastric tube and Foley catheter were inserted. A blood sample for serum electrolytes and complete blood count were taken. Antibiotics (ceftriaxone and metronidazole) were administered (15).\u0026nbsp;At surgery the gut viability was assessed and the type of surgery done noted. The patients were followed up till discharge to asses for early outcomes specifically morbidity (surgical site infection, burst abdomen and anastomotic leakage), length of hospital stays and mortality. Patients who were still admitted on the 30\u003csup\u003eth\u003c/sup\u003e day were considered to have been hospitalized for more than 30 days and considered not to have died.\u003c/p\u003e\n\u003ch2\u003eStudy variables\u003c/h2\u003e\n\u003cp\u003eThe dependent variables were early adverse outcome including\u0026nbsp;complications (wound sepsis, wound dehiscence, anastomotic leak and others), prolonged hospital stay and mortality.\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;Independent variables included social-demographics like (age, sex, residence and smoking) and clinical factors like (Vital signs and gut viability and laboratory findings). The intervening variable was the type of surgery: Sigmoidectomy + Primary anastomosis, or Hartmans procedure.\u003c/p\u003e\n\u003ch2\u003eQuality control\u003c/h2\u003e\n\u003cp\u003eThe data collection tool\u0026nbsp;was pretested for validity and reliability and adjustments made before starting data collection. The research protocol was explained to the research assistants during training. Every day, the principal investigator or his assistant double-checked the data to make sure it was accurate. A general surgeon supervised the research and all procedures were done by a qualified surgeon or a senior house officer under supervision of a general surgeon.\u003c/p\u003e\n\u003ch2\u003eData analysis\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eMicrosoft office excel was used to summarize data and then analysis was done by using SPSS version 26.0. Frequencies and percentages were used for the different elements of the clinical profile and early outcomes. For length of hospital stay, the median was reported since the length of stay was not normally distributed. Bivariate and multivariate analysis was done. Variables with P\u0026lt;0.2 were analysed at multivariate level. P values, risk ratios and confidence intervals obtained using Poisson regression were reported in tables with p\u0026lt;0.05 considered significant .This procedure was done for factors associated with mortality, occurrence of complications and prolonged hospital stay in order to report the specific factors for each of the 3 outcome categories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations and consent:\u003c/strong\u003e All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was granted by the Research and Ethics Committee of Mulago hospital (Ref No:\u0026nbsp;\u003cstrong\u003eMHREC 2538\u003c/strong\u003e). All participants gave written informed consent .\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study that enrolled 81 participants that underwent surgery for sigmoid volvulus, majority of the study participants were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Majority were from rural areas 58(71.6%) and only 17(21.0%) reported a history of smoking (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Baseline social demographic characteristics of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estudy participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72212978369384%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean=55.1, SD=14.2, Min=29, max=81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e29-45 (Middle aged adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e46 - 65 (Older adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e66-81(Elderly)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e75.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e71.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e79.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOf the 81 study participants, \u0026nbsp;27(33.3%) had both a low systolic blood pressure and a high pulse rate and therefore classified as hemodynamically unstable. Non-viable gut was found in 27(33.3%) of the participants. Fifteen (18.5%) of the patients had a bowel perforation. Majority of the patients had a colostomy placed 61(75.3%) either due to the condition of the gut or the hemodynamic status (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eClinical profile of patients undergoing surgery for sigmoid volvulus at JRRH, HRRH and FRRH\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemodynamic stability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.061564059900164%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eStable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eUn stable (PR\u0026gt;100, SBP\u0026lt;90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGut Viability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eViable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eNon-viable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBowel perforation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e81.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBowel procedure done\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.938435940099836%\" valign=\"top\"\u003e\n \u003cp\u003eColostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e75.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePR=Pulse rate, SBP=Systolic blood pressure.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 10 of the patients died representing a mortality of 12.3%. Thirty seven (45.7%) of the participants had at least one complication with the commonest complication being surgical site infection seen in 21(25.9%) of the study participants. The median length of hospital stay was 8(IQR=7-11) days with 40(49.4) of the patients staying in hospital for a duration above the median (\u0026gt;8 days) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEarly outcomes of surgery among patients with sigmoid volvulus at JRRH, HRRH and FRRH\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.06322795341098%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003eNo complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003eOne or more complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSurgical site infection\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e21\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e25.9\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eBurst abdomen\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e3.7\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eLeakage\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e2.5\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eSuperficial wound dehiscence\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e9\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e11.1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eOther complication (DVT=3, respiratory complications=5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e8\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e9.9\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62.06322795341098%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMedian=8, IQR= 7-11, Min=3, Max=18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le; Median (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93677204658902%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.785357737104825%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.277870216306155%\" valign=\"top\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIQR= Interquartile range,\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P\u0026lt;0.001) independently predicted mortality in multivariate analysis. The risk of mortality was increased by 2.210 times among patients that had hyperkalemia, while it was increased by 1.913 times among patients that had a sigmoid perforation (Table 4). Detailed bivariate analysis is shown in supplementary file 1 as table S1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Multivariate analysis of factors associated with Mortality\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.252525252525253%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.37373737373738%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.37373737373738%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.857142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.857142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.857142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eaRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.857142857142858%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e0.674-10.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.674-6.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e4.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e0.482-33.879\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.652-11.879\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e3.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e0.822-18.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.672-8.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptom duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;3 (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e4+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e1.352-6.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.512-7.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e1.464-8.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.464-5.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSodium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e0.850-5.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.850-6.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e1.485-8.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.485-6.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePotassium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e1.305-4.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e2.0547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e0.557-7.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.684\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.913-9.426\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.210\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.512-3.630\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerforation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.31578947368421%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.600\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.421-28.250\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.913\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.015-3.962\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;more likely to have blood culture positive sepsiss (aOR=red patient who had a d the symptoms was\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA history of hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P\u0026lt;0.001) independently predicted occurrence of complications in multivariate analysis. The risk of complications was increased by 2.726 times in hypertensive patients while it was increased by 2.500 times among patients that had hemodynamic instability (Table 5). Detailed bivariate analysis is shown in supplementary file 1 as table S2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Multivariate analysis of factors associated with occurrence of complications\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.510204081632654%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.755102040816325%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.535211267605632%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.67605633802817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eaRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.535211267605632%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e29-45 (Middle aged adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e46 - 65 (Older adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.471-4.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.011-1.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e66+(Elderly)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.687-7.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.007-3.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.932\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.183-7.267\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.726\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.206-6.158\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.625\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.661-4.149\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.561-4.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptom duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;3 (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e4+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.045-6.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e5.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.909-28.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.736-4.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.341-7.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSodium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.760-4.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.178-2.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.166-3.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.010-1.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerforation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e4.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.217-14.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.150-8.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eAnastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eColostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.819-7.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.261-4.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;more likely to have blood culture positive sepsiss (aOR=red patient who had a d the symptoms was\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and having hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) independently predicted prolonged hospital stay in multivariate analysis. A patient who presented after 3 days of symptoms was 1.217 times more likely to have prolonged hospital stay, while one who had hemodynamic instability was 1.165 times more likely to have prolonged hospital stay (Table 6). Detailed bivariate analysis is shown in supplementary file 1 as table S3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Multivariate analysis of factors associated with prolonged hospital stay.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.510204081632654%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.755102040816325%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.535211267605632%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.67605633802817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eaRR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.535211267605632%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.084507042253522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e29-45 (Middle aged adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e46 - 65 (Older adults)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.632-5.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.046-3.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e66+(Elderly)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e4.898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.386-17.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.071-17.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e3.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.078-8.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.797-1.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.873-5.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.833-1.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.643-11.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.882-1.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e3.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.916-14.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.949-1.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.857\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.747-13.506\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.165\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.017-1.335\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptom duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le;3 (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.358\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.190-1.550\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.217\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.016-1.458\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR/tenderness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.788-4.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.825-1.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSodium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e4.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.505-10.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.306-6.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.352-6.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.004-2.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerforation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.169-1.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e5.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.572-49.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eViability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eViable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eNon-viable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.106-7.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.429-8.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eAnastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eColostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e4.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.302-12.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.373-7.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eClinical profile.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study enrolled 81 participants that underwent surgery for sigmoid volvulus, majority of whom were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. This is because sigmoid volvulus is known to be common among males in the older age groups (40-50) years in third world countries (16). Majority were from rural areas 58(71.6%) probably due to the catchment area of the hospitals being rural settings.\u003c/p\u003e\n\u003cp\u003eWe noted that\u0026nbsp;27(33.3%) of the study participants had both a low systolic blood pressure and a high pulse rate and therefore classified as hemodynamically unstable. This percentage was higher than that reported in\u0026nbsp;Turkey where hemodynamic instability was seen among 102 (24.3%) of the patients presenting with sigmoid volvulus (17).\u0026nbsp;The difference could be because in this study a big number of patients had bowel gangrene or sigmoid perforation which both worsen the condition of the patient resulting in hypotension and tachycardia which constituted hemodynamic instability in this study.\u003c/p\u003e\n\u003cp\u003eNon-viable gut was found in 27(33.3%) of the participants while 15 (18.5%) of the patients had a bowel perforation. Percentage of non-viable gut in this study was higher than that reported by Mulugeta \u0026amp; Awlachew (18)\u0026nbsp;in Ethiopia where 26% had non-viable bowel but was lower than the percentage reported by Selçuk Atamanalp (17)\u0026nbsp;in\u0026nbsp;\u0026nbsp; Turkey (63.1%) and\u0026nbsp;Emna\u0026nbsp;(19)\u0026nbsp;in Tunisia (40%). The high percentage of non-viable bowel seen in our study is mainly because of delayed presentation where 46.9% of the study participants presented after 3 days of symptoms. Delay was probably due to inaccessibility of hospital from the rural areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMajority of the patients had a colostomy placed 61(75.3%) either due to the condition of the gut or the hemodynamic status. This percentage was comparable to the one reported by\u0026nbsp;Lee\u0026nbsp;(20)\u0026nbsp;in\u0026nbsp;Korea\u0026nbsp;(74.3%) but higher than that reported by\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;(14)\u0026nbsp;in Tanzania and\u0026nbsp;Okello\u0026nbsp;(21)\u0026nbsp;in Uganda at Mulago national referral hospital. The studies in Tanzania and Mulago had both emergency procedures and some elective procedure in which the volvulus was de-rotated endoscopically and then surgery done later. All the patients operated in our study underwent an emergency laparotomy and this could explain the difference in percentage of patients that had a stoma placed since emergency surgery increases possibility of stoma placement (22).\u0026nbsp;The other explanations for having a big number of patients undergoing stoma placement could be because of the significant number of patients with bowel gangrene, hemodynamic instability and perforation with gross contamination which conditions increase the risk for anastomotic leakage making stoma placement the safer option.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly outcomes\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 10\u0026nbsp;of the patients died representing a mortality of 12.3%. Our findings were in agreement with findings of a systematic review by\u0026nbsp;Selvaraj \u0026amp; Palaniswamy\u0026nbsp;(23)\u0026nbsp;who reported that mortality following sigmoid volvulus ranged from 10-50%. Also the mortality found in this study was comparable though slightly lower than that reported in Mulago (15.9%) (21)\u0026nbsp;and Tanzania (17%) (14).\u003c/p\u003e\n\u003cp\u003eThe mortality we found was higher than that reported by\u0026nbsp;Awedew\u0026nbsp;(24)\u0026nbsp;in Ethiopia (6.45%),\u0026nbsp;Jumbi \u0026amp; Kuremu\u0026nbsp;(25)\u0026nbsp;in Kenya (3.3%) and\u0026nbsp;Wismayer\u0026nbsp;(10)\u0026nbsp;in northern Uganda (7.7%). The differences seen in mortality could be because these studies that reported lower mortality had some patients operated electively after derotation yet in our study there were no facilities for endoscopic derotation, yet emergency procedures are associated with a higher mortality (15).\u0026nbsp;Also the high percentage of patients with perforated sigmoid\u0026nbsp;(18.5%)\u0026nbsp;could have contributed to the high mortality.\u003c/p\u003e\n\u003cp\u003eThirty seven (45.7%) of the participants had at least one complication with the commonest complication being surgical site infection seen in 21(25.9%) of the study participants. The percentage of patients with complications was comparable to that reported by\u0026nbsp;Lee\u0026nbsp;(20)\u0026nbsp;where 40.0% of the patients that had emergency surgery for sigmoid volvulus got complications. Also our findings were in agreement with studies by\u0026nbsp;Emna\u0026nbsp;(19)\u0026nbsp;in Tunisia,\u0026nbsp;Mulugeta \u0026amp; Awlachew\u0026nbsp;(18)\u0026nbsp;in Ethiopia,\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;(14)\u0026nbsp;in Tanzania and\u0026nbsp;Wismayer\u0026nbsp;(10)\u0026nbsp;in northern Uganda who reported surgical site infection as the commonest complication. This is possibly because these surgeries would be classified as contaminated or even dirty if there is perforation which classifications are associated with a high risk of surgical site infection.\u003c/p\u003e\n\u003cp\u003eThe percentage of complications reported in our study was higher than that reported by\u0026nbsp;Jumbi \u0026amp; Kuremu\u0026nbsp;(25)\u0026nbsp;in Kenya (21.7%),\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;(14)\u0026nbsp;in Tanzania (20.5%) and\u0026nbsp;Wismayer\u0026nbsp;(10)\u0026nbsp;in northern Uganda (17.5%). The high percentage of complications in this study could be attribute to the fact that a high percentage of the patients had perforated sigmoid\u0026nbsp;(18.5%)\u0026nbsp;which resulted in peritonitis. Given that surgical site infection was the commonest complication, the peritonitis could partly explain the high percentage of complications. The occurrence of sigmoid perforation can again be attributed to late presentation seen among most of the patients in our study since the median duration of symptoms at presentation was 3 days.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median length of hospital stay was 8(IQR=7-11) days with 40(49.4) of the patients staying in hospital for a duration above the median (\u0026gt;8 days). This LOS was comparable to that reported by\u0026nbsp;Awedew\u0026nbsp;(24)\u0026nbsp;in Ethiopia (median=8 days) but slightly lower than that reported by\u0026nbsp;Lee\u0026nbsp;(20)\u0026nbsp;in Korea (Median =11 days),\u0026nbsp;Jumbi \u0026amp; Kuremu\u0026nbsp;(25)\u0026nbsp;in Kenya (average 11.8 days) and\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;(14)\u0026nbsp;in Tanzania (Median=14 days). The High length of hospital stay could be attributed to the high occurrence of complications which are known to increase length of hospital stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with early adverse outcomes.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe variables that were independently and significantly associated with mortality were hyperkalemia and presence of a sigmoid perforation. Our findings were in agreement with what was reported by\u0026nbsp;Lee\u0026nbsp;(20)\u0026nbsp;in Korea who noted that mortality was significantly associated with presence of sigmoid colon gangrene or perforation (P=0.001),\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;(14)\u0026nbsp;in Tanzania who reported that bowel gangrene or perforation predicted adverse outcomes\u0026nbsp;and\u0026nbsp;Wismayer\u0026nbsp;(10)\u0026nbsp;in northern Uganda who reported that electrolyte imbalances were associated with unfavourable outcomes. Presence of hyperkalemia may be an indicator of acute kidney injury which has a potential to increase mortality while sigmoid perforation results in generalized peritonitis which significantly increases mortality.\u003c/p\u003e\n\u003cp\u003eThe variables that were independently and significantly associated with occurrence of complications were a history of hypertension and presence of hemodynamic instability. Our findings are in agreement with what was reported by\u0026nbsp;Lee\u0026nbsp;(20)\u0026nbsp;in Korea who noted that patients who had a concomitant disease like hypertension (P=0.001) and those who had hemodynamic instability or shock (P=0.001) had an increased risk of getting complications (20).\u0026nbsp;Also in agreement are the findings by\u0026nbsp;Okello\u0026nbsp;(21)\u0026nbsp;at mulago who reported that patients who had comorbid diseases like, hypertension had increased risk (21).\u0026nbsp;Hemodynamic instability increases the risk of complications since it impairs healing and hence increasing risk of wound complications and even anastomotic leakage. Presence of hypertension more so if poorly controlled impairs perfusion of the tissues due to the associated arteriosclerosis impairing the healing of tissues and hence the occurrence of wound complications.\u003c/p\u003e\n\u003cp\u003eThe variables that were independently and significantly associated with prolonged hospital stay were duration of symptoms greater than 3 days and having hemodynamic instability. Though many studies have reported about length of stay among patients undergoing sigmoid volvulus surgery, this is the first study that has reported on the factors associated with length of stay following surgery for sigmoid volvulus to best of our knowledge. Delayed presentation increases the risk of bowel ischemia, gangrene and perforation. These in turn increase the risk of post-operative complications as was reported by\u0026nbsp;Chalya \u0026amp; Mabula\u0026nbsp;\u0026nbsp;(14), which complications eventually results in prolonged hospital stay. The presence of hemodynamic instability also results in complications which in turn increase the length of hospital stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength and limitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a multicentre prospective cohort study that increases the generalizability of the findings.\u003c/p\u003e\n\u003cp\u003eHowever, our findings are limited by the fact that the centres did not have endoscopic services which can be used to de-rotate volvulus and do the surgeries electively; which procedure has been associated with a better outcome. Therefore our finding may not be generalizable to the centres where endoscopic derotation is practiced.\u003c/p\u003e\n\n\n"},{"header":"Conclusion and recommendations","content":"\u003cp\u003eA big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. Hyperkalemia and presence of a sigmoid perforation independently predicted mortality. Hypertension and presence of hemodynamic instability predicted occurrence of complications. Duration of symptoms greater than 3 days and hemodynamic instability independently predicted prolonged hospital stay.\u003c/p\u003e\u003cp\u003eMore sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn will improve the outcomes. All hospitals should be equipped with colonoscopy towers to enable derotation of some of the patients with sigmoid volvulus in whom derotation is indicated. Another multicentre prospective cohort should be done in hospitals that are able to do endoscopic derotation to assess the outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ecRR=Crude risk ratio, aRR=Adjusted risk ratio, CI=Confidence interval.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations and consent:\u003c/strong\u003e All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was granted by the Research and Ethics Committee of Mulago hospital (\u003cstrong\u003eMHREC 2538\u003c/strong\u003e). All participants gave written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData is available upon request upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding\u003c/strong\u003e: This study did not receive any specific grant from funding agencies in public, commercial, or not for profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution: S.A.K.\u0026nbsp;\u003c/strong\u003ewas the Principal investigator, conceived and designed the study, collected data, analysed data and wrote the draft of the manuscript. \u003cstrong\u003eJ.M.\u0026nbsp;\u003c/strong\u003eparticipated in data analysis, discussion of results and revised the manuscript. \u003cstrong\u003eD.A. and R.M.\u0026nbsp;\u003c/strong\u003esupervised the work and revised the manuscript. \u003cstrong\u003eM.D.O., U.K., J.I.K. and R.C.B.\u003c/strong\u003e participated in data collection, revised the manuscript and all authors approved the final paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe acknowledge all study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSarfaraz M, Hasan SR, Lateef S. Sigmoid volvulus in young patients: A new twist on an old diagnosis. Intractable and Rare Diseases Research. 2017;6(3):219\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eNaveed M, Jamil L, Fujii-Lau L. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo- obstruction and colonic volvulus. Gastrointest Endosc. 2020;91(2):228\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eAssenza M, Ciccarone F, Iannone I, Bracchetti G, de Meis E, Santillo S, et al. Elective treatment of large-bowel obstruction in asymptomatic sigmoid volvulus. Clinica Terapeutica. 2020;171(6):E466\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eSeow-En I, Chang SC, Ke TW, Shen MY, Chen HC, William Tzu-Liang Chen. Uncomplicated Sigmoid Volvulus Is Ideal for Laparoscopic Sigmoidectomy with Transrectal Natural Orifice Specimen Extraction. Diseases of the Colon and Rectum. 2021;5:E90\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003ePerrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg. 2016;153:183\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eHalabi W, Jafari M, Kang C. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg. 2014;259:293\u0026ndash;301. \u003c/li\u003e\n\u003cli\u003eRaveenthiran V, Madiba T, Atamanalp S, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12:e1\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eToh JWT, Collins GP, Ridley LJ, Chan M, Schofield R. A tale of two twists: mesentero‐axial and organo‐axial sigmoid volvulus. Journal of Medical Imaging and Radiation Oncology. 2022 Jun 30; \u003c/li\u003e\n\u003cli\u003eAli M, Hashmi Z, Zafar A. Management of acute sigmoid volvulus, using one stage resection and anastomosis, without colonic lavage.. J Med Sci. 2009;7(2):101\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eWismayer R. Incidence and Factors Influencing the Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study. In: Highlights on Medicine and Medical Science Vol 5. 2021. p. 8\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eTumusiime G, Kakande I, Masira N. Factors associated with redundant sigmoid colon at Mulago Hospital, Kampala. East Centr Afr J Surg. 2009;14:65\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eOkeny PK, Hwang TG, Ogwang DM. Acute Bowel Obstruction in a Rural Hospital in Northern in Northern Uganda. East Cent Afr j surg. 2011;V(1). \u003c/li\u003e\n\u003cli\u003eSaba M, Rosenberg J, Wu G, Hinika G. A case of sigmoid volvulus in an unexpected demographic. Surgical Case Reports. 2021;7(1):3\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eChalya PL, Mabula JB. Sigmoid volvulus and ileo-sigmoid knotting: A five-year experience at a tertiary care hospital in Tanzania. World Journal of Emergency Surgery. 2015;10(1):4\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eKazem shahmoradi M, khoshdani farahani P, Sharifian M. Evaluating outcomes of primary anastomosis versus Hartmann\u0026rsquo;s procedure in sigmoid volvulus: A retrospective-cohort study. Annals of Medicine and Surgery. 2021;62(January):160\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eDavid N, Bimston M, Steven J, Stryker M. Volvlus of the colon. Second. Current therapy in colon and rectal surgery. 2005. 557\u0026ndash;612 p. \u003c/li\u003e\n\u003cli\u003eAtamanalp SS, Aydinli B, \u0026Ouml;zt\u0026uuml;rk G, Başoǧlu M, Yildirgan MI, \u0026Ouml;ren D, et al. Classification of sigmoid volvulus. Turkish Journal of Medical Sciences. 2008;38(5):425\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eMulugeta GA, Awlachew S. Retrospective study on pattern and outcome of management of sigmoid volvulus at district hospital in Ethiopia. BMC Surgery. 2019;19(1):1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eEmna T, Atef M, Sarra S. Management of acute sigmoid volvulus: A Tunisian experience. Asian Journal of Surgery. 2022;45(1):148\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eLee K, Oh HK, Cho JR, Kim M, Kim DW, Kang SB, et al. Surgical management of sigmoid volvulus: A multicenter observational study. Annals of Coloproctology. 2020;36(6):403\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eOkello T, Ogwang D, Kisa P, Komagum P. Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary\u0026rsquo;s Hospital Lacor in Gulu, Uganda. T.R. Okello , D.M. Ogwang, P. Kisa, P. Komagum. St. Mary\u0026rsquo;s Hospital Lacor, Gulu, Northern Uganda. East Cent Afr j surg (Online) ISSN 2073-9990. 2009;14(2):58\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eKim EM, Kang BM, Kim BC, Kim JY, Park JH, Oh BY, et al. Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea. International Journal of Colorectal Disease. 2020;35(10):1841\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eSelvaraj DR, Palaniswamy C. Sigmoid volvulus. Journal of Hospital Medicine. 2010;5(4):9\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eAwedew AF. Magnitude and Clinical characteristics of Sigmoid Volvulus. Reserch squire. 2020;1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eJumbi G, Kuremu RT. Emergency resection of sigmoid volvulus. East African Medical Journal. 2008;85(8):398\u0026ndash;405. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sigmoid volvulus, clinical profile, adverse outcomes, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-4020748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4020748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003cbr\u003e\n\u003c/strong\u003eIn Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus. Due to unavailability of endoscopic services in some settings, most of the patients usually undergo emergency surgery. The aim of this study was to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja, Hoima and Fortportal regional referral hospitals (FRRH, HRRH and FRRH respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was an observational prospective cohort done at 3 regional referral hospitals in Uganda. Patients undergoing surgery for sigmoid volvulus were enrolled consecutively and followed up till the time of discharge or death to document the mortality, occurrence of complications and length of hospital stay. Data analysis was done using SPSS version 26 with Poisson regression done to determine the factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003cbr\u003e\n\u003c/strong\u003eIn this study that enrolled 81 participants, majority were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Hemodynamic instability was seen in 27(33.3%), non-viable gut in 27(33.3%) with colostomies placed in 61(75.3%) of the participants. Death occurred in 10(12.3%) of the patients, while 37(45.7%) had at least one complication with the commonest complication being surgical site infection 21(25.9%). The median length of hospital stay (LOS) was 8(IQR=7-11) days. At multivariate level of analysis, hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P\u0026lt;0.001) were independently associated with mortality, hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P\u0026lt;0.001) associated with occurrence of complications, while duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) were independently associated with prolonged hospital stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn could improve the outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-12 15:04:35","doi":"10.21203/rs.3.rs-4020748/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2c781b4-1a28-4ec6-b2bb-04176c7cf74c","owner":[],"postedDate":"March 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-05T07:10:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-12 15:04:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4020748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4020748","identity":"rs-4020748","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}