title: Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis.
abstract: OBJECTIVE
  Tertiary peritonitis is a severe persisting intra-abdominal infection and associated with high mortality. The aim was to find significant risk factors for mortality and tertiary peritonitis including the Mannheim Peritonitis Index (MPI), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a sumscore of both.
  
  
  METHODS
  In this retrospective single-center cohort study, 122 patients were treated at the Surgical Department of a University Hospital.
  
  
  RESULTS
  Sixty-nine patients (56.6%) developed tertiary peritonitis. Nineteen patients (27.5%), who suffered from tertiary peritonitis, died in contrast to eight patients (15.1%) with secondary peritonitis (P = 0.101). Patients with tertiary peritonitis had significantly higher APACHE II (P < 0.001), MPI (P = 0.035), and combined APACHE II and MPI scores (P < 0.001) than patients with secondary peritonitis. Age (P = 0.035), fungal infections (P = 0.025), and infections with more than one microbial organism (P = 0.047) were predictive for tertiary peritonitis. Combined APACHE II and MPI scores detected tertiary peritonitis better than the MPI (P = 0.014). Detection of mortality was comparable in all evaluated prognostic scores.
  
  
  CONCLUSIONS
  Prognostic scores besides age and fungal infections are risk factors for mortality and help to differentiate between secondary and tertiary peritonitis. The combination of prognostic scores is comparable to the APACHE II and superior compared to the MPI in regard to detection of tertiary peritonitis.
authors.affiliation: Department of General Surgery, E21 A, University Clinic of Surgery, Medical University of Vienna, Vienna, Austria. peter.panhofer@meduniwien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Panhofer
authors.forename: Barbara
authors.initials: B
authors.lastname: Izay
authors.forename: Markus
authors.initials: M
authors.lastname: Riedl
authors.forename: Veronika
authors.initials: V
authors.lastname: Ferenc
authors.forename: Martin
authors.initials: M
authors.lastname: Ploder
authors.forename: Raimund
authors.initials: R
authors.lastname: Jakesz
authors.forename: Peter
authors.initials: P
authors.lastname: Götzinger
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D001431:Bacteriological Techniques; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D012372:ROC Curve; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate