Prognostic factors and scoring system for survival in colonic perforation.
OBJECTIVE
No ideal and generally accepted prognostic factors and scoring systems exist to determine the prognosis of peritonitis associated with colonic perforation. This study was designed to investigate prognostic factors and evaluate the various scoring systems to allow identification of high-risk patients.


METHODS
Between 1996 and 2003, excluding iatrogenic and trauma cases, 26 consecutive patients underwent emergency operations for colorectal perforation and were selected for this retrospective study. Several clinical factors were analyzed as possible predictive factors, and APACHE II, SOFA, MPI, and MOF scores were calculated.


RESULTS
The overall mortality was 26.9%. Compared with the survivors, non-survivors were found more frequently in Hinchey's stage III-IV, a low preoperative marker of pH, base excess (BE), and a low postoperative marker of white blood cell count, PaO2/FiO2 ratio, and renal output (24h). According to the logistic regression model, BE was a significant independent variable. Concerning the prognostic scoring systems, an APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to poor prognosis.


CONCLUSIONS
Preoperative BE and postoperative white blood cell count were reliable prognostic factors and early classification using prognostic scoring systems at specific points in the disease process are useful to improve our understanding of the problems involved.
Komatsu
Shuhei
S
Department of Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan. skomatsu@koto.kpu-m.ac.jp
Shimomatsuya
Takumi
T
Nakajima
Masayuki
M
Amaya
Hirokazu
H
Kobuchi
Taketsune
T
Shiraishi
Susumu
S
Konishi
Sayuri
S
Ono
Susumu
S
Maruhashi
Kazuhiro
K
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003108:Colonic Diseases / Q000401:mortality* / Q000601:surgery; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate