Prognostic factors in critically ill patients suffering from secondary peritonitis: a retrospective, observational, survival time analysis.
BACKGROUND
Acute mortality of unselected critically ill patients has improved during the last 15 years. Whether these benefits also affect survival of critically ill patients with secondary peritonitis is unclear as is the relevance of specific prognostic factors, such as source control.


METHODS
We performed a retrospective analysis of data collected prospectively from March 1993 to February 2005. A cohort of 319 consecutive postoperative patients with secondary peritonitis requiring intensive care was evaluated. End points for outcome analysis were derived from daily changes of hazard rate.


RESULTS
Four-month survival rate after intensive care unit (ICU) admission was 31.7%. For patients who have survived for more than 4 months, the 1-year survival was 82.7%. After adjustment for relevant covariates, a high disease severity at ICU admission and during ICU stay, specific comorbidities (extended malignancies, liver cirrhosis) and sources of infection (distal esophagus, stomach), and an inadequate initial antibiotic therapy were associated with worse 4-month prognosis. Inability to obtain source control was the most important determinant of mortality, and treatment after 2002 was combined with improved prognosis.


CONCLUSIONS
Four-month prognosis of critically ill, surgical patients with secondary peritonitis is poor and mostly determined by the ability to obtain source control. Outcome has improved since 2002, and after successful surgical and intensive care therapy long-term survival seems to be good.
Schneider
Christian P
CP
Department of Surgery, Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
Seyboth
Carol
C
Vilsmaier
Markus
M
Küchenhoff
Helmut
H
Hofner
Benjamin
B
Jauch
Karl-Walter
KW
Hartl
Wolfgang H
WH
D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors