title: Predictive relevance of clinical scores and inflammatory parameters in secondary peritonitis.
abstract: OBJECTIVE
  To measure and evaluate clinical scores and various inflammation parameters for providing a better outcome assessment of patients with secondary peritonitis.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  ICU of a university and a university affiliated hospital.
  
  
  METHODS
  Fifty-six patients with severe secondary peritonitis were enrolled in this study executed within 4 years.
  
  
  RESULTS
  Blood samples were taken preoperatively and 2, 6, 8, 12, 18, 24, 30, 36, 42 and 48 hours post operation, thereafter every 12th hour until day 5 respectively once daily until day 14. Etiology of peritonitis, clinical score systems (APACHE II, MOF and SOFA), and 27 mainly with activity tests or enzyme-immunoassays measurable inflammation parameters were simultaneously analyzed and stratified into lethal outcome (n = 11) or survival (n = 45), respectively. The etiological distribution of peritonitis was identical among both groups. Proportion of intraperitoneal fungi, E. coli, and bacteroids was substantially higher during the primary operation in the group with lethal outcome. With increasing significance initial and follow-up APACHE II, MOF and SOFA scores provided higher values in this group. Various plasma/serum parameters of hemostasis, leukocyte proteolytic system, acute phase reaction, cytokine system, cell adhesion, opsonization, and main organ functions showed significantly different values between both groups at the preoperative stage and/or during observation period I (day 0-4). Logistic regression analysis revealed the SOFA score and neopterin concentration as the combination with the best sensitivity (63.6%) and specificity (93.2%) for predicting the patients' survival even at the preoperative stage. For the observation period I, the combination of SOFA score and TNF receptor II showed the highest predictive sensitivity (72.7%) and specificity (95.6%).
  
  
  CONCLUSIONS
  Evaluation of the severity of secondary peritonitis using a scoring system with high prognostic relevance could conceivably result in an earlier and adequate application of intensive care such as hemofiltration, administration of immunoglobulins and serial abdominal lavage to improve successful outcome.
authors.affiliation: Department of General and Visceral Surgery, Centre Hospitalier Emile Mayrisch, Luxembourg. nikolaus.zuegel@chem.lu
authors.forename: Nikolaus P
authors.initials: NP
authors.lastname: Zügel
authors.forename: Martin
authors.initials: M
authors.lastname: Kox
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtwark-Aschoff
authors.forename: Cornelia
authors.initials: C
authors.lastname: Gippner-Steppert
authors.forename: Marianne
authors.initials: M
authors.lastname: Jochum
mesh_terms: D018806:APACHE; D003422:Critical Care / Q000379:methods; D006305:Health Status Indicators; D006440:Hemofiltration; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D019798:Neopterin / Q000097:blood; D010538:Peritonitis / Q000097:blood* / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D047889:Receptors, Tumor Necrosis Factor, Type II; D019798:Neopterin; D019272:Leukocyte Elastase