Preoperative Fibrinogen Predicting the Occurrence of Ovarian Torsion in Children

Abstract

Abstract Background: Ovarian torsion (OT) is a rare occurrence in the pediatric population, characterized by a wide range of clinical manifestations, and a delayed diagnosis can have a profound impact on fertility. Although lower abdominal pain, nausea, and vomiting are commonly associated with OT, these presentations are predominantly atypical. Moreover, diagnosing OT in children poses a significant challenge due to the often unreliable expression of symptoms in this population. It is imperative to analyze the clinical characteristics of OT in children and adolescents and identify specific indicators in order to enhance the promptness and precision of preoperative OT diagnosis. Methods: Our study encompassed all female individuals (<18 years old) who were suspected of OT and underwent surgical intervention from August 2006 to February 2023. Pertinent clinical and laboratory information was gathered from the patients, and subsequently, they were categorized into two groups based on the presence or absence of torsion. We conducted univariate significance analysis, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curves to ascertain autonomous factors that could forecast OT in pediatric patients. Result: The findings revealed that OT transpired in 160 (33.6%) out of the 475 female subjects included in our study. Univariate and multivariable logistic regression analysis of the gathered data revealed three risk factors that were significantly linked to OT : Body temperature [1.5464 (1.3838, 1.7283), P = 1.5099e-14]; AFR [1.2238 (1.0857, 1.3795), P = 0.0009]; Fibrinogen [4.4145 (2.1538, 9.048), P = 0.0001]. The effectiveness of the three independent impact factors was examined using ROC curves. The result is body temperature (ROC 1, AUC = 0.6108, CI: 0.5487-0.6729), AFR (ROC 2, AUC = 0.5794, CI: 0.5132-0.6456) and fibrinogen (ROC 3, AUC = 0.7306, CI: 0.6649-0.7962). The area under the curve of the three independent predictors were compared to determine whether there was a difference in predictive efficacy. The results showed that the predictive efficacy of fibrinogen was significantly higher than that of body temperature and AFR (ROC1/ROC2: P = 0.4571>0.05, ROC1/ROC3: P = 0.6408>0.05, ROC2/ROC3: P = 0.0002<0.05). Conclusions: Our study suggests that fibrinogen can be an independent predictor of OT in girls.