Lebedev N V, Popov V S, Klimov A E, Svanadze G T
Peoples' Friendship University of Russia, Moscow, Russia.
Khirurgiia (Mosk). 2021(2):27-31. doi: 10.17116/hirurgia202102127.
To compare the most common prognostic systems in patients with peritonitis.
The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors.
Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis.
PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.
比较腹膜炎患者中最常见的预后评估系统。
该研究纳入了352例继发性腹膜炎患者。入院时，15例（4.3%）患者被诊断为脓毒症，4例（1.1%）为感染性休克。死亡的主要相关原因如下：化脓性中毒和/或脓毒症——51例（87.9%），癌症引起的中毒——4例（6.9%），急性心血管衰竭——3例（5.2%）。我们分析了曼海姆腹膜指数（MPI）、世界急诊外科学会（WSES）预后评分、急性生理与慢性健康状况评分系统II（APACHE-II）、序贯器官衰竭评估（gSOFA）评分以及作者开发的腹膜炎预测系统（PPS）的有效性。
患者年龄、恶性肿瘤、渗出液性质、脓毒症（感染性休克）以及与腹膜炎无关的器官衰竭是预测致命结局的最重要标准。采用受试者工作特征（ROC）分析来评估各种预测系统的预后价值。所有评分系统的标准误差均小于0.05。因此，所有预测系统均可被认为对预测腹膜炎患者的死亡率具有准确性。
在预测晚期继发性腹膜炎患者的致命结局方面，PPS（曲线下面积[AUC]为0.942）具有最高的准确性，APACHE II（AUC为0.840）的准确性最低。MPI的预测准确率也>90%。
