Organ dysfunction and long term outcome in secondary peritonitis.
OBJECTIVE
Secondary peritonitis is still associated with high mortality, especially when multiorgan dysfunction complicates the disease. Good prognostic tools to predict long term outcome in individual patients are lacking and therefore require further study.


METHODS
163 consecutive patients with secondary peritonitis were included, except those with postoperative or traumatic peritonitis. In 58 patients treated in the intensive care unit (ICU), organ dysfunction was quantified using Sequential Organ Failure Assessment (SOFA) score in the first 4 days. Predictive factors for poor outcome were evaluated in all patients. Hospital and 1-year mortality was assessed.


RESULTS
Hospital mortality was 19% and 1-year mortality 23%. Acute physiology and chronic health evaluation II (APACHE II), previous functional status, and sepsis category were predictive of fatal outcome in the total cohort (p = 0.034, p < 0.001, and p < 0.001). In patients treated in the ICU, advanced age and admission SOFA score were independent predictors of death (p = 0.014, p < 0.0001). The SOFA score showed the best discriminative ability for poor outcome (AuROC 0.78).


CONCLUSIONS
Degree of organ dysfunction measured using SOFA score was the best predictor of hospital mortality in patients suffering from secondary peritonitis.
Hynninen
M
M
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, 00029 HUS Helsinki, Finland. marja.hynninen@hus.fi
Wennervirta
J
J
Leppäniemi
A
A
Pettilä
V
V
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D001777:Blood Coagulation / Q000502:physiology; D002319:Cardiovascular System / Q000503:physiopathology; D002490:Central Nervous System / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007416:Intestinal Perforation / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D008099:Liver / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology*; D010538:Peritonitis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors