Bini Roberto, Ronchetta Clemente, Picotto Silvia, Scozzari Gitana, Gupta Shailvi, Frassini Simone, Chiara Osvaldo
University of Milan, General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
General Surgery Unit, Ospedale San Giovanni Bosco, Turin, Italy.
Ann Transl Med. 2020 Nov;8(21):1421. doi: 10.21037/atm-20-2184.
Gastrointestinal (GI) perforations are an acute surgical dilemma, with diagnostic workup often requiring abdominal imaging. Post-operative care for these patients may vary and oftentimes includes ICU care for sepsis, but not always. We evaluated if free fluid and air on computed tomography (CT) could be associated with sepsis, septic shock and mortality in GI perforations. The aim of our study was a correlation between a new CT-scan scoring system and septic complications in GI perforations.
We conducted an observational retrospective study about patients who underwent emergency surgery for intestinal perforation between January 2014 and June 2017. Inclusion criteria were a CT-scan positive for free fluid and air, and an intestinal perforation confirmed intraoperatively. A CT-score was created to evaluate location and extent of free fluid and air related to clinical outcome and prognosis. Univariate analysis between the CT score and the various clinical outcomes was conducted with the non-parametric Mann-Whitney test for continuous variables and with the chi-square test for categorical variables.
One-hundred and fifty-one patients were evaluated. The mortality was 23.18% and the complications were present in 45.95%. The median CT score for patients who developed complications was 3, compared with a value of 2 in the absence of complications (P=0.008). A CT score of 4 or greater had a sensitivity and specificity for predicting pre-operative sepsis of 73.33% and 64.42% respectively, and for pre-operative septic shock of 35.56% and 93.27%. Looking at post-operative sepsis, sensitivity and specificity were 57.45% and 70.19%, and for septic shock 36.17% and 85.85%. Spearman correlation analysis revealed that at higher scores at CT score corresponded higher scores at the P-POSSUM morbidity, P-POSSUM mortality and WSES Sepsis Severity Score.
Our CT score shows a significant correlation with validated predictive scoring systems with regards to predicting sepsis, septic shock and complications-and seems to be a useful outcome predictor in GI perforation.
胃肠道穿孔是一种急性外科难题，诊断检查通常需要进行腹部影像学检查。这些患者的术后护理可能各不相同，通常包括针对脓毒症的重症监护病房护理，但并非总是如此。我们评估了计算机断层扫描（CT）上的游离液体和气体是否与胃肠道穿孔患者的脓毒症、感染性休克及死亡率相关。我们研究的目的是探讨一种新的CT扫描评分系统与胃肠道穿孔患者感染性并发症之间的相关性。
我们对2014年1月至2017年6月期间因肠穿孔接受急诊手术的患者进行了一项观察性回顾性研究。纳入标准为CT扫描显示游离液体和气体阳性，且术中证实有肠穿孔。创建了一个CT评分来评估游离液体和气体的位置及范围与临床结局和预后的关系。对CT评分与各种临床结局进行单因素分析，连续变量采用非参数曼-惠特尼检验，分类变量采用卡方检验。
共评估了151例患者。死亡率为23.18%，并发症发生率为45.95%。发生并发症患者的CT评分中位数为3，无并发症患者的评分为2（P = 0.008）。CT评分为4或更高时，预测术前脓毒症的敏感性和特异性分别为73.33%和64.42%，预测术前感染性休克的敏感性和特异性分别为35.56%和93.27%。对于术后脓毒症，敏感性和特异性分别为57.45%和70.19%，对于感染性休克分别为36.17%和85.85%。Spearman相关性分析显示，CT评分越高，P-POSSUM发病率、P-POSSUM死亡率和WSES脓毒症严重程度评分越高。
我们的CT评分在预测脓毒症、感染性休克和并发症方面与经过验证的预测评分系统具有显著相关性，似乎是胃肠道穿孔有用的结局预测指标。
