Evaluation of prognostic factors and scoring system in colonic perforation.
OBJECTIVE
To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation.


METHODS
A total of 26 patients (9 men, 17 women; mean age 72.7+/-11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation II (APACHE II), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA II) scores were calculated preoperatively.


RESULTS
Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non-survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE II score was significantly lower in survivors than in non-survivors (10.4+/-3.84 vs 19.3+/-2.87, P=0.00003). Non-survivors tended to display high MPI score and low PIA II score, but no significant difference was identified.


CONCLUSIONS
Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE II score is most associated with prognosis and scores>or=20 are associated with significantly increased mortality rate.
Horiuchi
Atsushi
A
Department of Surgery 2, Ehime University School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan. atsushi@m.ehime-u.ac.jp
Watanabe
Yuji
Y
Doi
Takashi
T
Sato
Kouichi
K
Yukumi
Syungo
S
Yoshida
Motohira
M
Yamamoto
Yuji
Y
Sugishita
Hiroki
H
Kawachi
Kanji
K
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000293:injuries*; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis