Related Experiment Video
Updated: Jul 20, 2026
Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
Severity scoring systems for prognosis and efficacy of polymyxin B-immobilized fiber treatment for colonic
Shuhei Komatsu1, Takumi Shimomatsuya, Masayuki Nakajima
1Department of Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan.
Purpose:
There is no established system for predicting prognosis and evaluating the efficacy of antiseptic treatments such as polymyxin B-immobilized fiber (PMX) according to the severity of peritonitis in patients with colonic perforation. We investigated the predictive value of various severity scoring systems for survival and for the efficacy of antiseptic treatments, to identify high-risk patients.
Methods:
We reviewed 26 consecutive patients who underwent emergency operations between 1996 and 2003 for colorectal perforation not caused by trauma or iatrogenic disease. Several severity scores, i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) were calculated and analyzed as predictive scoring systems for prognosis, survival and efficacy of PMX treatment.
Results:
An APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to a poor prognosis. With or without PMX treatment, an APACHE II score of 15 or less, a SOFA score of 7 or less, an MPI score of 27 or less, and an MOF score of 7 or less were all related to a good prognosis. Conversely, all patients died when the severity scoring points were higher than 20 in APACHE II, higher than 12 in SOFA, and higher than 39 in MPI. When PMX treatment was given to patients with an intermediate score, no correlation between survival and its efficacy was found, except in the MOF scoring system.
Conclusion:
These severity scoring systems can assist with the prediction of prognosis. They may also be useful for determining if PMX treatment would be unnecessary or ineffective in certain patients. However, the optimal application of PMX treatment in selected patients according to the severity scoring systems needs further investigation.
Insights
Severity scoring systems like APACHE II and SOFA can predict prognosis in colonic perforation patients. These scores may guide the use of polymyxin B-immobilized fiber (PMX) treatment, though optimal application requires further study.
Area of Science:
- Surgical Gastroenterology
- Critical Care Medicine
- Medical Informatics
Background:
- Peritonitis from colonic perforation lacks established prognostic and treatment efficacy prediction systems.
- Polymyxin B-immobilized fiber (PMX) is an antiseptic treatment whose efficacy may vary with disease severity.
Purpose of the Study:
- To evaluate the predictive value of severity scoring systems for prognosis and antiseptic treatment efficacy in colonic perforation.
- To identify high-risk patients requiring closer monitoring or alternative interventions.
Main Methods:
- Retrospective review of 26 patients with non-traumatic, non-iatrogenic colonic perforation undergoing emergency surgery.
- Calculation and analysis of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) scores.
- Correlation of scores with patient prognosis, survival rates, and efficacy of PMX treatment.
Main Results:
- APACHE II ≥ 19, SOFA ≥ 8, MPI ≥ 30, and MOF ≥ 7 indicated poor prognosis.
- APACHE II ≤ 15, SOFA ≤ 7, MPI ≤ 27, and MOF ≤ 7 correlated with good prognosis.
- High scores (APACHE II > 20, SOFA > 12, MPI > 39) were associated with mortality. PMX efficacy showed no clear correlation with intermediate scores, except for MOF.
Conclusions:
- Established severity scoring systems (APACHE II, SOFA, MPI, MOF) can predict prognosis in colonic perforation.
- These scores may help determine the necessity or effectiveness of PMX treatment in specific patient groups.
- Further research is needed to optimize the application of PMX treatment based on these severity scores.
