Department of Surgery, School of Medicine, Makerere University, Kampala, Uganda.
Department of Physiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda.
BMC Surg. 2022 Jul 28;22(1):291. doi: 10.1186/s12893-022-01743-4.
The majority of the prognostic scoring tools for peritonitis are impractical in low resource settings because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA) score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis.
This was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital, or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals.
We evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a significantly better discriminative ability (AUC = 0.893, 95% CI 0.801-0.986) than the qSOFA score (AUC = 0.770, 95% CI 0.620-0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2), were 58.8% and 98.3% respectively.
The in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic tool for peritonitis cases in the emergency department.
大多数用于腹膜炎的预后评分工具在资源匮乏的环境中并不实用，因为它们很复杂，而其他工具则相当昂贵。快速相关性器官衰竭评估（qSOFA）评分和腹部感染相关生理学指标用于腹膜炎严重程度评分（PIPAS）是两种严格的床边预后工具，但它们对腹膜炎死亡率的预测能力尚未进行比较。我们比较了 qSOFA 标准和 PIPAS 严重程度评分对腹膜炎住院死亡率的预测能力。
这是一项在乌干达一家三级医院接受手术治疗的连续腹膜炎病例的前瞻性队列研究，时间为 2020 年 10 月至 2021 年 6 月。对每个病例术前进行 PIPAS 严重程度评分和 qSOFA 评分评估，然后对所有病例进行术中及术后随访，直至出院，或如果住院时间延长则随访 30 天；主要观察终点为住院死亡率。我们使用接受者操作特征曲线分析评估和比较这两种工具对腹膜炎住院死亡率的预测能力。所有检验均为双侧（p < 0.05），置信区间为 95%。
我们评估了 136 例腹膜炎病例。他们的平均年龄为 34.4 岁（标准差= 14.5）。男女比例为 3:1。腹膜炎的总住院死亡率为 12.5%。PIPAS 严重程度评分对腹膜炎死亡率的区分能力（AUC= 0.893，95%CI 0.801-0.986）明显优于 qSOFA 评分（AUC= 0.770，95%CI 0.620-0.920）（p= 0.0443）。最佳 PIPAS 严重程度截断值评分（评分> = 2）的灵敏度和特异性分别为 76.5%和 93.3%，而 qSOFA 标准（评分> = 2）的相应值分别为 58.8%和 98.3%。
本腹膜炎病例队列的住院死亡率较高。与 qSOFA 评分工具相比，PIPAS 严重程度评分工具对腹膜炎住院死亡率具有更好的预测能力和更高的灵敏度，尽管后者工具的特异性更高。我们建议在急诊科将 PIPAS 严重程度评分作为腹膜炎病例的初始预后工具。
