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APACHE-II scoring system in perforative peritonitis.

Srikanth V Kulkarni¹, Anitha S Naik, Nirmala Subramanian

¹Department of General Surgery, M.S. Ramaiah Medical College and Teaching Hospital, Bangalore-560 054 Karnataka, India.

American Journal of Surgery

|September 11, 2007

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The Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score effectively predicts mortality risk in patients with hollow viscus perforation peritonitis. Scores between 11-20 show high accuracy, though individual predictions require caution.

Area of Science:

Critical Care Medicine
Surgical Outcomes Research
Medical Informatics

Background:

The Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scoring system is established for stratifying disease severity in intra-abdominal sepsis.
Objective discrimination between low-risk and high-risk patient groups has been demonstrated using APACHE-II.

Purpose of the Study:

To evaluate the performance of the APACHE-II scoring system in predicting mortality risk.
To assess APACHE-II's accuracy in patients experiencing peritonitis due to hollow viscus perforation.

Main Methods:

A prospective study of 50 patients with peritonitis from hollow viscus perforation over 2 years.
APACHE-II scores were calculated for each patient pre-operatively to determine individual mortality risk.

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Outcome prediction accuracy was analyzed using receiver operating characteristic (ROC) curves and Pearson correlation coefficient.

Main Results:

The study included 50 patients, with 84% survivors and 16% nonsurvivors.
The mean APACHE-II score was 11.38; nonsurvivors had a significantly higher mean score (19.25) than survivors (9.88).
ROC analysis yielded an area under the curve of 0.984, indicating high predictive accuracy. Scores of 11-15 and 16-20 demonstrated high sensitivity and specificity.

Conclusions:

APACHE-II scores between 11 and 20 are effective predictors of mortality risk in hollow viscus perforation peritonitis.
While useful for assessing group outcomes, APACHE-II lacks sufficient confidence for precise individual patient outcome prediction, especially for scores outside the 11-20 range.