Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Authors:
Dr Agron Dogjani, MD, PhD, FACS
Dr Agron Dogjani, MD, PhD, FACS
University Hospital of Trauma
Professor Associate of Surgery
General Surgeon
Tirana | Albania
Massimo Sartelli Fikri M Abu-Zidan Francesco M Labricciosa Yoram Kluger Federico Coccolini Luca Ansaloni Ari Leppäniemi Andrew W Kirkpatrick Matti Tolonen Cristian Tranà Jean-Marc Regimbeau Timothy Hardcastle Renol M Koshy Ashraf Abbas Ulaş Aday A R K Adesunkanmi Adesina Ajibade Lali Akhmeteli Emrah Akın Nezih Akkapulu Alhenouf Alotaibi Fatih Altintoprak Dimitrios Anyfantakis Boyko Atanasov Goran Augustin Constança Azevedo Miklosh Bala Dimitrios Balalis Oussama Baraket Suman Baral Or Barkai Marcelo Beltran Roberto Bini Konstantinos Bouliaris Ana B Caballero Valentin Calu Marco Catani Marco Ceresoli Vasileios Charalampakis Asri Che Jusoh Massimo Chiarugi Nicola Cillara Raquel Cobos Cuesta Luigi Cobuccio Gianfranco Cocorullo Elif Colak Luigi Conti Yunfeng Cui Belinda De Simone Samir Delibegovic Zaza Demetrashvili Demetrios Demetriades Ana Dimova Mushira Enani Federica Farina Francesco Ferrara Domitilla Foghetti Tommaso Fontana Gustavo P Fraga Mahir Gachabayov Grelpois Gérard Wagih Ghnnam Teresa Giménez Maurel Georgios Gkiokas Carlos A Gomes Ali Guner Sanjay Gupta Andreas Hecker Elcio S Hirano Adrien Hodonou Martin Hutan Igor Ilaschuk Orestis Ioannidis Arda Isik Georgy Ivakhov Sumita Jain Mantas Jokubauskas Aleksandar Karamarkovic Robin Kaushik Jakub Kenig Vladimir Khokha Denis Khokha Jae Il Kim Victor Kong Dimitris Korkolis Vitor F Kruger Ashok Kshirsagar Romeo Lages Simões Andrea Lanaia Konstantinos Lasithiotakis Pedro Leão Miguel León Arellano Holger Listle Andrey Litvin Aintzane Lizarazu Pérez Eudaldo Lopez-Tomassetti Fernandez Eftychios Lostoridis Davide Luppi Gustavo M Machain V Piotr Major Dimitrios Manatakis Marianne Marchini Reitz Athanasios Marinis Daniele Marrelli Aleix Martínez-Pérez Sanjay Marwah Michael McFarlane Mirza Mesic Cristian Mesina Nickos Michalopoulos Evangelos Misiakos Felipe Gonçalves Moreira Ouadii Mouaqit Ali Muhtaroglu Noel Naidoo Ionut Negoi Zane Nikitina Ioannis Nikolopoulos Gabriela-Elisa Nita Savino Occhionorelli Iyiade Olaoye Carlos A Ordoñez Zeynep Ozkan Ajay Pal Gian M Palini Kyriaki Papageorgiou Dimitris Papagoras Francesco Pata Michał Pędziwiatr Jorge Pereira Gerson A Pereira Junior Gennaro Perrone Tadeja Pintar Magdalena Pisarska Oleksandr Plehutsa Mauro Podda Gaetano Poillucci Martha Quiodettis Tuba Rahim Daniel Rios-Cruz Gabriel Rodrigues Dmytry Rozov Boris Sakakushev Ibrahima Sall Alexander Sazhin Miguel Semião Taanya Sharda Vishal Shelat Giovanni Sinibaldi Dmitrijs Skicko Matej Skrovina Dimitrios Stamatiou Marco Stella Marcin Strzałka Ruslan Sydorchuk Ricardo A Teixeira Gonsaga Joel Noutakdie Tochie Gia Tomadze Lara Ugoletti Jan Ulrych Toomas Ümarik Mustafa Y Uzunoglu Alin Vasilescu Osborne Vaz Andras Vereczkei Nutu Vlad Maciej Walędziak Ali I Yahya Omer Yalkin Tonguç U Yilmaz Ali Ekrem Ünal Kuo-Ching Yuan Sanoop K Zachariah Justas Žilinskas Maurizio Zizzo Vittoria Pattonieri Gian Luca Baiocchi Fausto Catena

World J Emerg Surg 2019 15;14:34. Epub 2019 Jul 15.

153Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.

Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.

Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.

Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

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http://dx.doi.org/10.1186/s13017-019-0253-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631509PMC
July 2019
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