Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis

Bosscha, K.; Reijnders, Koen; Hulstaert, P. F.; Algra, Ale; Werken, Christiaan van der

doi:10.1002/bjs.1800841110

Cited by 128 publications

(106 citation statements)

References 15 publications

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“…Several risk scores exist for the prediction of outcomes in patients with perforated peptic ulcer. [8][9][10] Among the most frequently used are the ASA classification, the Boey score, MPI and the more recently introduced PULP score. However, only the Boey and PULP scores are specifically designed for the prediction of mortality in PPU patients.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer

Nichakankitti

Athigakunagorn

2016

Int Surg J

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INTRODUCTIONIn urgent surgical procedures for perforated peptic ulcer (PPU), there is considerable postoperative morbidity and mortality. The overall mortality rate is about 9-27%.1-3 A large number of prognostic factors for morbidity and mortality in patients with perforated peptic ulcer have been reported. [2][3][4][5][6][7] Several clinical scoring system have been proposed for prognostic prediction. The most wellknown predicted scoring system is Boey score 3, which predicted mortality in PPU patients base on the time from perforation to admission, pre-operative systolic blood pressure and comorbid conditions of patients. Then Boey score was classified in three groups, score 0, 1 and 2 and mortality rate were 0%, 10% and 100% respectively. Lohsiriwat et al was found that a higher Boey score was associated with increasing rates of both morbidity and mortality and could be considered as a simple and appropriate prognostic marker in the management of PPU. 1The American society of anesthesiologists (ASA) classification is the most commonly used for assessing perioperative risk worldwide. It is graded in six categories; depend on the patient's pre-operative health status. 5 The previous study found that ASA classification ABSTRACT Background: To determine the accuracy of Boey score, American society of anesthesiologists (ASA) score, peptic ulcer perforation (PULP) score and the mannheim peritonitis index (MPI) score and compare each predicted scoring systems for prediction the morbidity and mortality of patients with perforated peptic ulcer. Methods:We retrospectively reviewed the patients with gastric or duodenal ulcer perforation in Bhumibol Adulyadej Hospital, Bangkok, Thailand between 1 January 2008 and 31 December 2012. The morbidity and mortality within 30 days of the PPU patient who underwent the surgical procedure was determined. The predicted scoring systems included Boey score, ASA score, PULP score and MPI score were calculated. We used area under curve of receiver operating characteristics curve to compare the scoring accuracy. Results:The study included 140 patients, Female 17.9% and male 82.1%. The mean age was 48.5 years. The most common site of PPU was the pre-pyloric region (80%). The most common operative procedure was the simple suture with omental graft. The complication rate was 20.71%. Overall mortality rate was 3.57%. The AUC for morbidity prediction was 0.671 for Boey score, 0.684 for ASA score, 0.698 for MPI score and 0.727 for PULP score. The AUC for mortality prediction was 0.728 for Boey score, 0.776 for ASA score, 0.771 for MPI score and 0.784 for PULP score. Conclusions:The PULP score may be the better prognostic scoring system for post-operative morbidity and mortality of PPU patient than Boey score, ASA and MPI.

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Section: Discussionmentioning

confidence: 99%

The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer

Nichakankitti

Athigakunagorn

2016

Int Surg J

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“…P eritonitis continues to be one of the major abdominal emergencies causing high in-hospital morbidity and mortality rates up to 38% (1)(2)(3). Although the overall mortality of sepsis is ϳ35% (4), abdominal sepsis is associated with mortality rates up to 80% (5).…”

Section: Il-10-deficient Mice Demonstrate Multiple Organ Failure and mentioning

confidence: 99%

IL-10-Deficient Mice Demonstrate Multiple Organ Failure and Increased Mortality DuringEscherichia coliPeritonitis Despite an Accelerated Bacterial Clearance

Sewnath¹,

Olszyna

Birjmohun³

et al. 2001

The Journal of Immunology

151

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To determine the role of endogenous IL-10 in local antibacterial host defense and in the development of a systemic inflammatory response syndrome during abdominal sepsis, IL-10 gene-deficient (IL-10−/−) and wild-type (IL-10+/+) mice received an i.p. injection with Escherichia coli. Peritonitis was associated with a bacterial dose-dependent increase in IL-10 concentrations in peritoneal fluid and plasma. The recovery of E. coli from the peritoneal fluid, blood, and lungs was diminished in IL-10−/− mice, indicating that endogenous IL-10 impaired bacterial clearance. Despite a lower bacterial load, IL-10−/− mice had higher concentrations of TNF, macrophage inflammatory protein-2 and keratinocyte in peritoneal fluid and plasma, and demonstrated more severe multiple organ damage as indicated by clinical chemistry and histopathology. Furthermore, IL-10−/− mice showed an increased neutrophil recruitment to the peritoneal cavity. To examine the role of elevated TNF levels in the altered host response in IL-10−/− mice, the effect of a neutralizing anti-TNF mAb was determined. Anti-TNF did not influence the clearance of E. coli in either IL-10+/+ or IL-10−/− mice. Furthermore, anti-TNF did not affect leukocyte influx in the peritoneal fluid, multiple organ damage, or survival in IL-10+/+ mice. In IL-10−/− mice, anti-TNF partially attenuated neutrophil recruitment and multiple organ damage, and prevented the increased lethality. These data suggest that although endogenous IL-10 facilitates the outgrowth and dissemination of bacteria during E. coli peritonitis, it protects mice from lethality by attenuating the development of a systemic inflammatory response syndrome by a mechanism that involves inhibition of TNF release.

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“…12 Although there were opinions that combination of APACHE II and MPI should be a standard classification system for grading severity of peritonitis and intra-abdominal sepsis. 13 Samir et al showed that MPI had no predictive power, while APACHE II does. 9 Organ failure is associated with prolonged stay and higher costs.…”

Section: Daysmentioning

confidence: 99%

A prospective study of prediction of outcomes in perforative peritonitis using apache II scoring system

2017

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Background: To predict the risk of mortality and morbidity in patients with perforative peritonitis using APACHE II scoring system. To evaluate the usefulness of APACHE II scoring system as a potential clinical and research tool which could be included as routine part of patient assessment in institution like ours.Methods: This was a prospective, observational study of prediction of outcomes in 80 patients of perforative peritonitis using APACHE II scoring system, conducted during the period of 2 years at our tertiary care institute.Results: Predicted death rate of the study was 17.31% and observed death rate was 25%. However, when observed and predicted death rates were compared in group of patients with APACHE II score of <10, it was over estimating the mortality. In group of patients with APACHE II score 11-20 and >20 it was underestimating the mortality. About 71.2% patients came under APACHE II score <10 with mortality of 3.5%. 23.7% came under group of patients with APACHE II score of 11-20 with mortality of 73.6% and only 5% patients had score >20 with 100% mortality were seen amongst them.Conclusions: In the present study, APACHE II scoring system was found to be accurate predictor of group outcome and can be effectively used in prediction of group outcome in similar population, but does not give sufficient confidence for outcome in an individual patient.

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Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis

Abstract: Combination of the APACHE II and the MPI provides the best scoring system fitting clinical goals.

Cited by 128 publications

References 15 publications

The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer

The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer

IL-10-Deficient Mice Demonstrate Multiple Organ Failure and Increased Mortality DuringEscherichia coliPeritonitis Despite an Accelerated Bacterial Clearance

A prospective study of prediction of outcomes in perforative peritonitis using apache II scoring system

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