Prognosis of risk in the development of tertiary peritonitis
DOI:
https://doi.org/10.11603/2414-4533.2017.3.8007Keywords:
abdominal sepsis, secondary peritonitis, tertiary peritonitis, prognostic score.Abstract
The aim of the work: to develop a score for predicting the risk of development of te rtiary peritonitis.
Materials and Methods. We examined 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Due to severity of postoperative condition, majority (68; 62.4 %) of patients stayed for 1–4 days in intensive care unit. The signs of the tertiary peritonitis were stated by 3–12 day in 20 (18.3 %) of patients. Postoperative mortality was 30.2 %. Tertiary peritonitis had 90 % of mortality. The comparison of rank and parameter values between the groups was performed using the Mann-Whitney U-criterion. To determine the relationship between qualitative characteristics, we used Fisher’s and Pearson’s χ2 criteria. Indicators were statistically processed by STATISTICA software (StatSoft Inc., USA).
Results and Discussion. Wald’s method was used to calculate the diagnostic coefficients for binary characteristics and separate ranges of indicators. Among 52 serially analyzed indicators, we had statistically extracted 19 most predictive and integrated them into the prediction table for the risk of development of tertiary peritonitis. In the perioperative period, the patient’s peripheral blood is tested for the level of hemoglobin and relative number of lymphocytes, the leukocyte index of intoxication and phagocytic index are counted, in the serum – the content of cortisol, procalcitonin, total protein, Ig A and M, interleukin-10, urea, APACHE-3 score are evaluated. Intraoperatively, the volume of peritoneal exudate is measured, diffuseness and separatedness of peritonitis are estimated, the number of affected areas of the abdomen are counted, duration of surgery and Mannheim peritonitis index are marked. Postoperatively, the duration of mechanical ventilation is taken into account. Depending on the amount of points, the risk of development of tertiary peritonitis is characterized from “very low” to “very high”. Verification of the developed scale on the independent continuous prospective group proved its high sensitivity, specificity and accuracy in predicting the risk of development of tertiary peritonitis.
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