Bosscha K, Reijnders K, Hulstaert P F, Algra A, van der Werken C
Department of Surgery, University Hospital of Utrecht, The Netherlands.
Br J Surg. 1997 Nov;84(11):1532-4.
Early classification of patients presenting with peritonitis and intra-abdominal sepsis by means of objective scoring systems is desirable to select patients for 'aggressive' surgery and to compare results of different treatment regimens. However, none of the existing scoring systems has fulfilled all expectations.
Evaluation of the value of various scoring systems (Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score, Sepsis Severity Score, Multiple Organ Failure, Mannheim Peritonitis Index (MPI), Ranson and Imrie) was performed in 50 patients. Additionally, scoring systems were combined to obtain a 'combined score' for the prediction of peritonitis-related in-hospital death. Hazard ratios were calculated in a univariate and multivariate analysis.
In the univariate analysis all scoring systems, except Ranson and Imrie, predicted the primary outcome. In the multivariate analysis, only the APACHE II score (hazard ratio 6.7) and the MPI (hazard ratio 9.8) contributed independently to the prediction of outcome. All patients with an APACHE II score of 20 or more and a MPI of 27 or more died in hospital.
Combination of the APACHE II and the MPI provides the best scoring system fitting clinical goals.
通过客观评分系统对腹膜炎和腹腔内脓毒症患者进行早期分类，有助于筛选出适合“积极”手术的患者，并比较不同治疗方案的效果。然而，现有的评分系统均未完全达到预期。
对50例患者的多种评分系统（急性生理与慢性健康状况评估（APACHE）II、简化急性生理评分、脓毒症严重程度评分、多器官功能衰竭、曼海姆腹膜炎指数（MPI）、兰森评分和伊姆里评分）进行评估。此外，将评分系统进行组合以获得预测腹膜炎相关院内死亡的“综合评分”。在单因素和多因素分析中计算风险比。
在单因素分析中，除兰森评分和伊姆里评分外，所有评分系统均能预测主要结局。在多因素分析中，只有APACHE II评分（风险比6.7）和MPI（风险比9.8）能独立预测结局。所有APACHE II评分达到或超过20且MPI达到或超过27的患者均在院内死亡。
APACHE II评分和MPI的组合提供了最符合临床目标的评分系统。
