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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
06:45

Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis

Published on: December 18, 2010

Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis

Peter Panhofer1, Barbara Izay, Markus Riedl

  • 1Department of General Surgery, E21 A, University Clinic of Surgery, Medical University of Vienna, Vienna, Austria. peter.panhofer@meduniwien.ac.at

Langenbeck'S Archives of Surgery
|March 18, 2008
PubMed
Abstract

Insights

Tertiary peritonitis, a severe infection, has high mortality. Prognostic scores like APACHE II and MPI help identify risk factors and differentiate peritonitis types, with combined scores showing superior detection for tertiary peritonitis.

Area of Science:

  • Surgical Infections
  • Critical Care Medicine
  • Prognostic Biomarkers

Background:

  • Tertiary peritonitis is a severe, persistent intra-abdominal infection with high mortality rates.
  • Identifying significant risk factors for mortality and differentiating tertiary from secondary peritonitis is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the Mannheim Peritonitis Index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score, and their combination, as risk factors for mortality and predictors of tertiary peritonitis.
  • To identify specific risk factors associated with the development of tertiary peritonitis.

Main Methods:

  • A retrospective single-center cohort study involving 122 patients treated at a university hospital's Surgical Department.
  • Analysis of patient data to compare the predictive capabilities of MPI, APACHE II, and a combined score for tertiary peritonitis and mortality.

Main Results:

  • Of 122 patients, 69 (56.6%) developed tertiary peritonitis. Mortality was higher in tertiary peritonitis (27.5%) compared to secondary peritonitis (15.1%).
  • Patients with tertiary peritonitis exhibited significantly higher APACHE II, MPI, and combined scores. Age, fungal infections, and polymicrobial infections were predictive of tertiary peritonitis.
  • Combined APACHE II and MPI scores demonstrated superior detection of tertiary peritonitis compared to MPI alone, while mortality detection was comparable across all prognostic scores.

Conclusions:

  • Prognostic scores, in addition to age and fungal infections, are significant risk factors for mortality in peritonitis.
  • The combination of prognostic scores effectively differentiates between secondary and tertiary peritonitis, with the combined score outperforming the MPI in detecting tertiary peritonitis.

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