Kologlu M, Elker D, Altun H, Sayek I
Hacettepe University Medical School Department of General Surgery, Ankara, Turkey.
Hepatogastroenterology. 2001 Jan-Feb;48(37):147-51.
BACKGROUND/AIMS: There are several scoring systems designed to predict mortality in patients with peritonitis, which need validation in different patient populations. Our aim was to evaluate Mannheim Peritonitis Index (MPI) and Peritonitis Index of Altona (PIA II) in patients with postoperative peritonitis and other causes of secondary peritonitis.
The records of patients operated for intraabdominal infection between 1987-1996 in Hacettepe University Department of General Surgery, were reviewed retrospectively. A total of 473 patients were included in the study; 75 of them had postoperative peritonitis (POSTOP group) and the remaining 398 had secondary peritonitis due to other causes (OTHER group). Using multiple logistic regression, MPI and PIA II were combined in an equation and this new variable was called combined peritonitis score (CPS); CPS = -9 + (0.3 x MPI) + (-1.2 x PIA II). All patients were scored according to MPI, PIA II and CPS. Receiver-operator characteristic (ROC) curves and sharpness of scores were compared. Also mean scores in both groups, proportions of correct predictions of outcome according to scores and correlation of scores with mortality were compared.
Overall mortality was 17.8% in OTHER group and 33.3% in POSTOP group (P = 0.0018). Higher MPI scores, lower PIA II scores and higher CPS scores were associated with higher mortality in both groups (P < 0.0001). Mean MPI values were higher, mean PIA II values were lower and mean CPS values were higher in POSTOP group (P < 0.001). The areas under ROC curves of CPS were bigger than MPI and PIA II in both groups. Sharpness of CPS was higher in both groups compared to MPI and PIA II (P < 0.05). Proportion of correct predictions of outcome was highest in CPS among the three scores (P = 0.0074). CPS had the best correlation with observed mortality.
POSTOP group patients had higher MPI, lower PIA II and higher CPS values ending up with higher mortality. This may be because of the delay in diagnosis and treatment, resulting with higher organ failure rates. Generally the results of evaluations for MPI and PIA II are similar. When these two peritonitis scores are combined and used together in the form of CPS, all the parameters improve.
背景/目的：有多种评分系统用于预测腹膜炎患者的死亡率，这些系统需要在不同患者群体中进行验证。我们的目的是评估曼海姆腹膜炎指数（MPI）和阿尔托纳腹膜炎指数（PIA II）在术后腹膜炎及其他继发性腹膜炎病因患者中的情况。
回顾性分析了1987年至1996年在哈杰泰佩大学普通外科接受腹部感染手术患者的病历。共有473例患者纳入研究；其中75例患有术后腹膜炎（POSTOP组），其余398例因其他原因患有继发性腹膜炎（OTHER组）。使用多元逻辑回归，将MPI和PIA II纳入一个方程，这个新变量称为联合腹膜炎评分（CPS）；CPS = -9 +（0.3×MPI）+（-1.2×PIA II）。所有患者均根据MPI、PIA II和CPS进行评分。比较了受试者工作特征（ROC）曲线和评分的锐利度。还比较了两组的平均评分、根据评分正确预测结局的比例以及评分与死亡率的相关性。
OTHER组的总体死亡率为17.8%，POSTOP组为33.3%（P = 0.0018）。两组中较高的MPI评分、较低的PIA II评分和较高的CPS评分均与较高的死亡率相关（P < 0.0001）。POSTOP组的平均MPI值较高，平均PIA II值较低，平均CPS值较高（P < 0.001）。两组中CPS的ROC曲线下面积均大于MPI和PIA II。与MPI和PIA II相比，两组中CPS的锐利度更高（P < 0.05）。在三个评分中，CPS对结局正确预测的比例最高（P = 0.0074）。CPS与观察到的死亡率相关性最佳。
POSTOP组患者的MPI较高，PIA II较低，CPS值较高，最终死亡率较高。这可能是由于诊断和治疗延迟，导致器官衰竭率较高。总体而言，MPI和PIA II的评估结果相似。当将这两个腹膜炎评分结合并以CPS的形式一起使用时，所有参数均得到改善。
