Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis.
OBJECTIVE
To evaluate the time-course of two organ failure scores (SOFA and Goris) after surgery for postoperative peritonitis in critically ill patients according to the persistence/nonpersistence of intraabdominal sepsis (IAS).


METHODS
Retrospective study.


METHODS
Sixty-two consecutive patients (SAPSII = 38+/-14) admitted in the surgical ICU.


METHODS
Patients were classified according to the persistence of IAS (IAS+, n=36) confirmed by a second laparotomy or the lack of IAS (IAS-, n=26) assessed by a favorable 30-day evolution without reintervention. Scores were calculated daily from day 0 preoperatively to postoperative day 5.


RESULTS
In both groups, SOFA scores were higher on day 1 when compared to day 0 (8.3+/-3.1 vs 6.1+/-3.7 in the IAS+ group and 5.2+/-3.4 vs 2.7+/-2.7 in the IAS- group). In the IAS- patients, the SOFA score displayed a decrease starting on day 2 when compared to day 1 (4.4+/-3.6 vs 5.2+/-3.4, P=0.03). In contrast, in the IAS+ patients, the SOFA score remained unchanged until day 5. The time course of the Goris score was strictly similar to the SOFA scores.


CONCLUSIONS
In critically ill patients with postoperative peritonitis, the postoperative time course of the SOFA and the Goris organ failure scores was different between patients with or without intra-abdominal persistent sepsis. The lack of improvement of one of these scores on postoperative day 2 may suggest persistent intraabdominal sepsis and supports the need for a new surgical exploration.
Paugam-Burtz
C
C
Department of Anesthesiology and Surgical ICU, Department of General Surgery, University Hospital Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France. catherine.paugam@bch.ap-hop-paris.fr
Dupont
H
H
Marmuse
J-P
JP
Chosidow
D
D
Malek
L
L
Desmonts
J-M
JM
Mantz
J
J
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis*; D010538:Peritonitis / Q000150:complications* / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors