Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK.
Department of General Surgery, North Manchester General Hospital, North Manchester Care Organisation, Manchester, UK.
Int J Colorectal Dis. 2021 May;36(5):1023-1031. doi: 10.1007/s00384-020-03822-5. Epub 2021 Jan 6.
To assess whether intraperitoneal contamination index (ICI) (Hajibandeh index) derived from combined levels of CRP, lactate, neutrophils, lymphocytes, and albumin can predict the nature of intraperitoneal contamination in patients with acute abdominal pathology and to assess whether ICI can predict postoperative mortality in patients undergoing emergency laparotomy.
In order to prospectively validate the ICI, developed and validated retrospectively in our previous study, a multicentre prospective cohort study was conducted between January 2019 and June 2020 including all adult patients who presented with acute abdominal pathology requiring emergency laparotomy. ROC curve analysis was performed to determine discrimination and cut-off values of preoperative ICI that could predict the nature of intraperitoneal contamination and postoperative mortality.
Overall, 269 patients were included in the prospective validation cohort which were compared with 234 patients in the primary cohort and 234 patients in the retrospective validation cohort. The analyses identified ICI of 24.76 as cut-off value for purulent contamination (AUC: 0.78, P < 0.0001; sensitivity: 82.4%, specificity: 60.9%); ICI of 33.84 as cut-off value for feculent contamination (AUC: 0.78, P < 0.0001; sensitivity: 82%, specificity: 67.8%), and ICI of 33.47 as cut-off value for postoperative mortality (AUC: 0.70, P < 0.0001; sensitivity: 72.7%, specificity: 58.47%). The results of the prospective validation cohort were comparable with the results of the primary and retrospective validation cohorts.
Hajibandeh index predicts the presence of purulent and feculent intraperitoneal contamination in patients with acute abdominal pathology and postoperative mortality in patients undergoing emergency laparotomy. Future studies should investigate the effect of ICI use on the accuracy of preoperative prognostic scoring tools and on patient selection for operative or non-operative management of underlying abdominal pathology.
评估基于 C 反应蛋白、乳酸、中性粒细胞、淋巴细胞和白蛋白水平综合得出的腹腔内污染指数（ICI）（Hajibandeh 指数）能否预测急性腹部病理患者腹腔内污染的性质，并评估 ICI 是否能预测接受急诊剖腹术患者的术后死亡率。
为了前瞻性验证我们之前的研究中回顾性开发和验证的 ICI，进行了一项多中心前瞻性队列研究，纳入了 2019 年 1 月至 2020 年 6 月期间所有因急性腹部病理需要接受急诊剖腹术的成年患者。通过 ROC 曲线分析确定术前 ICI 的鉴别和截断值，以预测腹腔内污染和术后死亡率的性质。
共有 269 例患者纳入前瞻性验证队列，与原发性队列的 234 例患者和回顾性验证队列的 234 例患者进行比较。分析确定 24.76 的 ICI 为脓性污染的截断值（AUC：0.78，P<0.0001；敏感性：82.4%，特异性：60.9%）；33.84 的 ICI 为粪性污染的截断值（AUC：0.78，P<0.0001；敏感性：82%，特异性：67.8%），以及 33.47 的 ICI 为术后死亡率的截断值（AUC：0.70，P<0.0001；敏感性：72.7%，特异性：58.47%）。前瞻性验证队列的结果与原发性和回顾性验证队列的结果相当。
Hajibandeh 指数可预测急性腹部病理患者腹腔内脓性和粪性污染的存在，以及接受急诊剖腹术患者的术后死亡率。未来的研究应调查 ICI 使用对术前预后评分工具准确性的影响，以及对接受手术或非手术治疗的患者的选择，以治疗潜在的腹部病理。
