Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in-hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study

Abstract

Background The majority of the prognostic scoring tools for peritonitis are impractical in low resource settings because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA) score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis. Method This was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital, or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals. Results We evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a significantly better discriminative ability (AUC = 0.893, 95% CI 0.801–0.986) than the qSOFA score (AUC = 0.770, 95% CI 0.620–0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2), were 58.8% and 98.3% respectively. Conclusions The in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic tool for peritonitis cases in the emergency department.

Typhoid intestinal perforation prognostic score in poor-resource settings

“…[ 4 8 , 12 25 , 28 ] As part of the prognostic evaluation of intra-abdominal sepsis, several scores and many predictive factors have been reported. [ 15 16 17 18 20 21 22 ] According to Biondo et al .,[ 16 ] to be useful, a classification and scoring system must be compatible with the concepts of physiopathology, aetiology of the disease, and surgical results. However, the use of these scores is not always easy especially in sub-Saharan Africa and other low-income countries.…”

“…[ 4 8 9 10 , 12 13 14 ] The predictive value of prognostic factors and several severity scoring systems of peritonitis has been previously described. [ 15 16 17 18 19 20 21 ] However, the use of these scoring systems is not always easy and adaptable to typhoid intestinal perforations (TIPs) in our context and other LMICs. Also, we asked ourselves the question of the usefulness of a prognostic score that can help assess the severity of intestinal typhoid perforation, a common surgical condition in our poor-resource settings.…”

Analysis of prognostic factors in patients with acute peritonitis

“…Recognized scales are PIPAS [4], WSES Sepsis Severity Score (WSSS) [8], Mannheim Peritonitis Index (MPI) [9], Peritonitis Index Altona [10], Combined Peritonitis Score [11]. These scales assess only the degree of organ dysfunction, the severity of AP and the possibility of a patient's death [12][13][14][15][16][17]. However, these scales do not assess the risk of certain complications.…”

A Scale for Predicting of the Complications in Patients With Acute Peritonitis

“…Найвідомішими й найбільш інформативними вважають шкали PIPAS [4], WSES Sepsis Severity Score (WSSS) [8], Mannheim Peritonitis Index (MPI) [9]. Однак суттєвими спільними недоліками є те, що вказані шкали дають змогу уніфікувати оцінювання тільки тяжкості ГП і, відповідно, ризик смерті хворих [10][11][12][13]. Водночас оцінювання за їхньою допомогою ризику виникнення окремих ПОУ не передбачено.…”