Introduction/Aim. Currently, there is no classification reflecting the severity of complicated intra-abdominal infections (cIAIs). Therefore, we aimed to create one and facilitate the prognostic assessment of cIAIs in clinical practice. Methods. This was a single-center study conducted at a University Hospital Stara Zagora including 140 patients with cIAIs. Retrospectively, for the period January 2017 -October 2018, we divided the patients with cIAIs into three groups according to their sequential organ failure assessment (SOFA) score and World Society of Emergency Surgery Sepsis Severity Score (WSES SSS) -mild cIAIs (SOFA < 2 points), severe cIAIs (SOFA ≥ 2) and severe complicated intra-abdominal sepsis (SCIAS) -WSES SSS ≥ 8 or septic shock. Prospectively, we validated the created classification in 62 patients with cIAIs between November 2018 and August 2021. Results. For the retrospective and prospective group, respectively, death rate among patients with mild cIAIs was 3.1% and 3.6%, with severe cIAIs -26.8% and 19%, and with SCIAS we observed the highest mortality -68.8% and 30.8%. Prognostic scores that differed significantly according to severity for both time periods were SOFA, Mannheim Peritonitis Index, and WSES SSS. Conclusion. The proposed classification has the potential to be a reliable predictor of severity in patients with cIAIs.
References
1.
Tolonen M, Coccolini F, Ansaloni L, Sartelli M, Roberts DJ, et al. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria. World Journal of Emergency Surgery. 2018;13(1).
2.
Tridente A, Clarke GM, Walden A, Gordon AC, Hutton P, Chiche JD, et al. Association between trends in clinical variables and outcome in intensive care patients with faecal peritonitis: analysis of the GenOSept cohort. Critical Care. 2015;19(1).
3.
Dellinger EP. Surgical Infection Stratification System for Intra-abdominal Infection. Archives of Surgery. 1985;120(1):21.
4.
Barie PS, Hydo LJ, Eachempati SR. Longitudinal Outcomes of Intra-abdominal Infection Complicated by Critical Illness. Surgical Infections. 2004;5(4):365–73.
5.
Ohmann C, Wittmann DH, Wacha H. Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group Eur J Surg. 1993;159(5):267–74.
6.
Blot S, Antonelli M, Arvaniti K, Blot K, Creagh-Brown B, et al. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project. Intensive Care Medicine. 2019;45(12):1703–17.
7.
Xue G, Liang H, Ye J, Ji J, Chen J, Ji B, et al. Development and Validation of a Predictive Scoring System for In-hospital Death in Patients With Intra-Abdominal Infection: A Single-Center 10-Year Retrospective Study. Frontiers in Medicine. 8.
8.
Pan J, Zhu Q, Zhang X, Xu J, Pan L, Mao X, et al. Factors Influencing the Prognosis of Patients with Intra-Abdominal Infection and Its Value in Assessing Prognosis. Infection and Drug Resistance. Volume 14:3425–32.
9.
Maseda E, Ramírez S, Picatto P, Peláez-Peláez E, García-Bernedo C, Ojeda-Betancur N, et al. Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality. PLOS ONE. 14(9):e0223092.
10.
Arvaniti K, Dimopoulos G, Antonelli M, Blot K, Creagh-Brown B, Deschepper M, et al. Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study. International Journal of Antimicrobial Agents. 2022;60(1):106591.
11.
Starr ME, Saito M, Evers BM, Saito H. Age-Associated Increase in Cytokine Production During Systemic Inflammation—II: The Role of IL-1β in Age-Dependent IL-6 Upregulation in Adipose Tissue. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015;70(12):1508–15.
12.
Pisani MA. Analytic Reviews: Considerations in Caring for the Critically Ill Older Patient. Journal of Intensive Care Medicine. 2009;24(2):83–95.
13.
Sartelli M, Abu-Zidan FM, Labricciosa FM, Kluger Y, Coccolini F, Ansaloni L, et al. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study. World Journal of Emergency Surgery. 2019;14(1).
14.
Wacha H, Linder MM, Feldman U. Mannheim peritonitis index -prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theoretical Surg. 1987;1:169–77.
15.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. Chest. 1992;101(6):1644–55.
16.
Kirkpatrick AW, Coccolini F, Ansaloni L, Roberts DJ, Tolonen M, et al. Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial. World Journal of Emergency Surgery. 2018;13(1).
17.
Menichetti F, Sganga G. Definition and Classification of Intra-abdominal Infections. Journal of Chemotherapy. 2009;21(sup1):3–4.
18.
Godínez-Vidal AR, Vázquez-Rentería R, Guerrero-Ponce AE. Use of the WSES scale to predict mortality in patients with intraabdominal infection. Rev Mex de Cirugía del Aparato Digestivo. 2020;9(2):65–70.
19.
Dimitrov E, Minkov G, Enchev E, Yovtchev Y. PROGNOSTIC PERFORMANCE OF WORLD SOCIETY OF EMERGENCY SURGERY SEPSIS SEVERITY SCORE IN BULGARIAN PATIENTS WITH COMPLICATED INTRA-ABDOMINAL INFECTIONS. Trakia Journal of Sciences. 19(3):253–8.
20.
Mwenda KI, Ojuka D, Awori M. Utility of World Society of Emergency Surgery Sepsis Severity Score in Predicting Outcomes of Intra-abdominal Infections. Annals of African Surgery. 17(2):65–8.
21.
Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World Journal of Emergency Surgery. 2015;10(1).
22.
Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World Journal of Emergency Surgery. 2014;9(1).
23.
Jung YT, Jeon J, Park JY, Kim MJ, Lee SH, Lee JG. Addition of lactic acid levels improves the accuracy of quick sequential organ failure assessment in predicting mortality in surgical patients with complicated intra-abdominal infections: a retrospective study. World Journal of Emergency Surgery. 2018;13(1).
24.
Nugraha GL, Septarendra D, Lesmana T. Comparative study of SOFA, WSESSSS, and CPIRO scoring systems as mortality predictors in a patient with complicated intra-abdominal infection. Bali Medical Journal. 11(3):1397–403.
25.
Jobin SP, Maitra S, Baidya DK, Subramaniam R, Prasad G, Seenu V. Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study. Journal of Intensive Care. 2019;7(1).
26.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801.
27.
Ferreira FL. Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. JAMA. 2001;286(14):1754.
28.
Lorente JA, Vallejo A, Galeiras R, Tómicic V, Zamora J, Cerdá E, et al. ORGAN DYSFUNCTION AS ESTIMATED BY THE SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE IS RELATED TO OUTCOME IN CRITICALLY ILL BURN PATIENTS. Shock. 2009;31(2):125–31.
29.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine. 1996;22(7):707–10.
30.
Vincent JL. International Study of the Prevalence and Outcomes of Infection in Intensive Care Units. JAMA. 2009;302(21):2323.
31.
Tochie JN, Agbor NV, Frank Leonel TT, Mbonda A, Aji Abang D, Danwang C. Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis. BMJ Open. 2020;10(1):e034326.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
