Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study

Abstract

Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO 2 ) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis

“…AGP affects about 9.3 patients per 1000 hospital admissions11 and requires adequate preoperative resuscitation to avert high perioperative morbidity and mortality 12 13. Although AGP is one of the most frequent surgical emergencies at the global level,8 14 it has been reported to disproportionately affect low-income and middle-income countries especially the sub-Saharan African (SSA) region both in terms of prevalence9 15 and mortality rates 16–18. The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation 9.…”

Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

“…This fact demonstrates the importance of timely admission and high predictive value of the medical history length for mortality. Different scoring systems to assess severity and prognosis of peritonitis are found in literature (15,16). Developed in 1987, Mannheim peritonitis index (MPI) remains highly recommended (17).…”

Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper

“…Further prognosticators of poor outcome in abdominal infections are advanced age, severe chronic cardiovascular and kidney disease, coexistent malignancy and immunodeficiency [ 25 , 26 ]. In perforated diverticulitis, however, high American Society of Anesthesiologists (ASA) score [ 20 ], severity of sepsis [ 23 ] and intraabdominal parameters [ 19 – 23 ] seem more relevant predictors of failure of conservative management.…”