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Table of Contents
LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 253-254

Prediction of outcome in perforation peritonitis: Sequential organ function assessment score and inflammatory mediators


Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

Date of Web Publication16-Jul-2018

Correspondence Address:
Vandna Arora
Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_91_17

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How to cite this article:
Arora V, Tyagi A, Verma G. Prediction of outcome in perforation peritonitis: Sequential organ function assessment score and inflammatory mediators. J Anaesthesiol Clin Pharmacol 2018;34:253-4

How to cite this URL:
Arora V, Tyagi A, Verma G. Prediction of outcome in perforation peritonitis: Sequential organ function assessment score and inflammatory mediators. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2019 Nov 15];34:253-4. Available from: http://www.joacp.org/text.asp?2018/34/2/253/236690



Madam,

Limited health resources of a developing country remain a logistic concern for patient care. Mortality prediction of patients may aid in optimal allocation of limited resources. Perforation peritonitis is the commonest surgical emergency in Indian subcontinent and still carries considerable morbidity and mortality.[1] We explored the utility of a clinical scoring system versus laboratory inflammatory markers for mortality prediction in patients of perforation peritonitis following emergency abdominal laparotomy. The investigated mortality predictors included sequential organ function assessment (SOFA) score, serum interleukin (IL)-10, and procalcitonin.

This is a secondary analysis of 120 patients of perforation peritonitis included for effect of anesthetic interventions on their clinical outcome. The original research was undertaken only after clearance from Institutional Ethical Committee. The SOFA score (n = 120) and systemic inflammatory mediators (n = 60) were assessed preoperatively and on specified postoperative days [Table 1]. The association between various indicators and mortality was evaluated using receiver operating characteristics (ROC) analysis, exhibiting an area under the curve (AUC) for strength of the association, if any. The ROC curve analysis showed lack of any significant relationship between 28-day mortality and preoperative IL-10 and procalcitonin (P = 0.928 and 0.351, respectively) as well as postoperative IL-10 (P = 0.569). It was significant for preoperative and postoperative SOFA score (P = 0.002 and 0.000, respectively) and postoperative procalcitonin on both second and fourth day (P = 0.025 and 0.039, respectively).
Table 1: Comparison of mortality predictors between survivors and nonsurvivors

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The AUC for preoperative and postoperative SOFA score was 0.77 (95% confidence interval (CI): 0.64–0.89) and 0.91 (95% CI: 0.83–0.99), and it was 0.78 (95% CI: 0.52–1.04) and 0.76 (95% CI: 0.53–1.00) for procalcitonin on second and fourth postoperative day, respectively.

The mean values of each of these mortality predictors were significantly worse among nonsurvivors (n = 12) as compared to survivors (n = 108) (P< 0.05) [Table 1].

Based on our observations, it appears that SOFA score correlates better than any of the inflammatory mediators (IL as well as procalcitonin) with mortality in these patients. Although there are studies noting utility of clinical scores including SOFA for predicting mortality in patients with perforation peritonitis, there is no comparison with inflammatory mediators.[2] Interestingly, we noted that postoperative SOFA score is a more accurate predictor than preoperative score similar to that observed in one other study.[3] This is perhaps a result of patients response to the surgery by this time, being manifested in the first day postoperative score. The inability of procalcitonin in predicting mortality of septic patients as compared to SOFA is evidenced earlier also, as is the failure of interleukins.[4],[5] Thus, we conclude that clinical score may still be better than laboratory markers for outcome prediction in perforation peritonitis, the commonest surgical emergency of our settings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India: Review of 504 consecutive cases. World J Emerg Surg 2006;1:26.  Back to cited text no. 1
    
2.
Hynninen M, Wennervirta J, Leppäniemi A, Pettilä V. Organ dysfunction and long term outcome in secondary peritonitis. Langenbecks Arch Surg 2008;393:81-6.  Back to cited text no. 2
    
3.
Copeland C, Young A, Grogan T, Gabel E, Dhillon A, Quraishi S,et al. 1526: Perioperative organ dysfunction predicts mortality in critically ill patients. Crit Care Med 2016;44:457.  Back to cited text no. 3
    
4.
Ruiz-Alvarez MJ, García-Valdecasas S, De Pablo R, Sanchez García M, Coca C, Groeneveld TW,et al. Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis. J Intensive Care Med 2009;24:63-71.  Back to cited text no. 4
    
5.
Haecker FM, Fasler-Kan E, Manasse C, Fowler B, Hertel R, von Schweinitz D. Peritonitis in childhood: Clinical relevance of cytokines in the peritoneal exudate. Eur J Pediatr Surg 2006;16:94-9.  Back to cited text no. 5
    



 
 
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