scholarly journals New System For Predicting The Outcome Of Secondary Peritonitis

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Nikolay V. Lebedev ◽  
Sariya B. Agrba ◽  
Vasily S. Popov ◽  
Alexey E. Klimov ◽  
Giorgy T. Svanadze
Keyword(s):  
Statistical Analysis ◽  
Abdominal Sepsis ◽  
Multiple Organ ◽  
Secondary Peritonitis ◽  
Apache Ii ◽  
Diffuse Peritonitis ◽  
Multiple Organ Dysfunction ◽  
Toxic Shock ◽  
Lethal Outcome ◽  
New System

Despite improvements in the methods of diagnostics, surgical interventions and intensive care, the problem of treating patients with diffuse peritonitis remains relevant. Diffuse peritonitis is a major contributor to mortality in all urgent care settings and the second leading cause of sepsis in critically ill patients. At the same time, even in developed countries, the number of patients with peritonitis does not tend to decrease, and mortality rates remain high, reaching 90-93% with the development of abdominal sepsis and toxic shock syndrome. One of the ways to reduce mortality in peritonitis is the use of objective systems for prognosis of the peritonitis outcome, allowing to compare the results of patient treatment and to choose the optimal treatment tactics for each particular patient. The objective — To develop a new system for predicting the outcome of secondary peritonitis (survival or death) focused on the criteria of abdominal sepsis and multiple organ dysfunction syndrome (associated or not associated with peritonitis), and to analyze its accuracy versus the most common comparable systems. Material and Methods — Our study was based on analyzing the treatment outcomes in 352 patients with secondary diffuse peritonitis. On admission, sepsis was diagnosed in 15 (4.3%), and toxic shock in 4 (1.1%) patients. The main causes of death were purulent intoxication and/or sepsis (51 cases or 87.9%), cancer intoxication (4 cases or 6.9%), and acute cardiac failure (3 cases or 5.2%). We analyzed the effectiveness of several systems of predicting the peritonitis outcomes: the Mannheim’s Peritoneal Index (MPI), World Society for Emergency Surgery Sepsis Severity Score (WSES SSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) system, general Sequential Organ Failure Assessment Score (gSOFA), as well as the Peritonitis Prognosis System (PPS) developed by the authors. The probability of the effect of 40 clinical and laboratory parameters on the outcome of patients with secondary peritonitis was analyzed via using parametric and nonparametric methods of statistical analysis (Fisher’s test, Mann-Whitney U test, Chi-squared test with Yates’s continuity correction). The criteria were selected that had a predictive power for the lethal outcome (p <0.05), and they were included in the PPS system. To compare the predictive value of the PPS, ROC analysis was conducted with construction of receiver operating characteristic curves for each analyzed system of predicting the peritonitis outcome. The STATISTICA 8 software was used for performing the statistical analysis. Results — The following criteria were of greatest importance in predicting the lethal outcome: a patient’s age, a presence of a malignant neoplasm, a nature of the exudate, the development of sepsis (toxic shock), as well as multiple organ dysfunction not associated with the developed peritonitis. PPS exhibited the greatest accuracy in terms of predicting mortality in patients with secondary diffuse peritonitis (AUC=0.942) versus minimal in APACHE II (AUC=0.840). Conclusion — APACHE II, MPI, WSES SSS and PPS can be considered reliable in terms of mortality prognosis in peritonitis patients. PPS has the greatest accuracy of predicting the mortality in patients with secondary diffuse peritonitis (94%).

scholarly journals Successful Treatment of Streptococcal Toxic Shock Syndrome with Both Diffuse Peritonitis and Necrotizing Fasciitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Shuichi Sato ◽  
Masahiro Ito ◽  
Tsuyoshi Sakai ◽  
Anri Kaneta ◽  
Fumie Sato
Keyword(s):  
Mechanical Ventilation ◽  
Necrotizing Fasciitis ◽  
Toxic Shock Syndrome ◽  
Multiple Organ ◽  
Streptococcal Toxic Shock Syndrome ◽  
Diffuse Peritonitis ◽  
Multiple Organ Dysfunction ◽  
Toxic Shock ◽  
Life Threatening ◽  
Uncommon Case

Streptococcal toxic shock syndrome (STSS) is a life-threatening disease caused by infection of beta-hemolytic streptococci. Here, we report an uncommon case of STSS with both diffuse peritonitis and necrotizing fasciitis and summarize previous cases. The patient was diagnosed with STSS due to an infection of the soft tissue of the lower extremity after surgery for diffuse peritonitis. The general condition had rapidly deteriorated with multiple organ dysfunction. Immediate intensive care, including mechanical ventilation, hemodiafiltration, and repeated debridement, is indispensable for a favorable outcome.

scholarly journals The Effects of Adjuvant Immunoglobulin M-Enriched Immunoglobulin Therapy on Mortality Rate and Renal Function in Sepsis-Induced Multiple Organ Dysfunction Syndrome: Retrospective Analysis of Intensive Care Unit Patients

2012 ◽  
Vol 40 (3) ◽  
pp. 1166-1174 ◽  
Author(s):  
L Yavuz ◽  
G Aynali ◽  
A Aynali ◽  
A Alaca ◽  
S Kutuk ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Intensive Care ◽  
Mortality Rate ◽  
Organ Dysfunction ◽  
Multiple Organ ◽  
Apache Ii ◽  
Control Group ◽  
Multiple Organ Dysfunction ◽  
Overall Mortality

OBJECTIVE: To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS: Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS: A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS: Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.

scholarly journals Aberrant miR-219-5p is correlated with TLR4 and serves as a novel biomarker in patients with multiple organ dysfunction syndrome caused by acute paraquat poisoning

2020 ◽  
Vol 34 ◽  
pp. 205873842097488
Author(s):  
Yunxiang Dai ◽  
Xia Liu ◽  
Yuming Gao
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Apache Ii ◽  
Luciferase Reporter ◽  
Apache Ii Score ◽  
Multiple Organ Dysfunction ◽  
Cox Regression Analysis ◽  
Potential Biomarker ◽  
Tnf Α

This study aimed to investigate the clinical significance of serum microRNA-219-5p (miR-219-5p) in patients with multiple organ dysfunction syndrome (MODS) caused by acute paraquat (PQ) poisoning, and its correlation with Toll-like Receptor 4 (TLR4). Luciferase reporter assay was used to investigate in vitro the correlation of miR-219-5p with TLR4. Serum miR-219-5p levels were evaluated by quantitative real-time polymerase chain reaction. Serum levels of TLR4, IL-1β, and TNF-α were measured by Enzyme-linked immune sorbent assay (ELISA). ROC analysis was performed to assess the diagnostic significance, Kaplan-Meier survival curves and Cox regression analysis were used to evaluate the prognostic value of miR-219-5p in MODS patients. TLR4 was a target gene of miR-219-5p and was increased in MODS patients. Serum miR-219-5p level was decreased and negatively correlated with TLR4 level in MODS patients ( r = −0.660, P < 0.001), which had important diagnostic value and negatively correlated with APACHE II score in MODS patients. The miR-219-5p expression was markedly associated with the WBC, ALT, AST, PaCO2, Lac, and APACHE II score. Non-survivals had more patients with low miR-219-5p expression. Patients with low miR-219-5p expression had shorter survival time. MiR-219-5p and APACHE II score were two independently prognostic factors for 28-day survival. MiR-219-5p was negatively correlated with, while TLR4 was positively correlated with the levels of IL-1β and TNF-α. The serum miR-219-5p level may be a potential biomarker for acute PQ-induced MODS diagnosis and prognosis. Furthermore, miR-219-5p may be associated with the progression of MODS by regulating TLR4-related inflammatory response.

scholarly journals Severity condition assessment in patients with intra-abdominal surgical infection

2011 ◽  
Vol 4 (1) ◽  
pp. 45-50
Author(s):  
Tatiana Petrovna Gvozdik ◽  
Vladimir Sergeevich Kononov ◽  
Mazhit Akhmetovich Nurtelecom
Keyword(s):  
Liver Dysfunction ◽  
Total Bilirubin ◽  
Severity Of Illness ◽  
High Sensitivity ◽  
Abdominal Sepsis ◽  
Apache Ii ◽  
Lethal Outcome ◽  
Laboratory Findings ◽  
Surgical Infection ◽  
Intra Abdominal Infection

The therapy outcome of 258 patients with intra-abdominal surgical site infection has been evaluated, 205 (79,5%) of which developed abdominal sepsis of different severity degrees. In order to assess risk factors of lethal outcome, the severity of illness and related organ dysfunction scores have been calculated by means of APACHE II, SAPS, MODS и SOFA, as well as the procalcitonin levels test laboratory findings (PCT). In the present study, procalcitonin levels evaluation has shown to be a high sensitivity test that provides objective information for an infectious process assessment, correlating to APACHE II scores (R2=0,86). The concomitant liver dysfunction has been revealed be the most unfavorable factor for intra-abdominal infection prognosis, being the direct cause of death in 28,3% cases. The most sensitive values are total bilirubin, alkaline phosphatase, triglyceride levels, with the highest correlation ratio R2=0,92, R2=0,89, R2=0,93, respectively, which allows their application as an early diagnostic procedure for liver dysfunction detection in this group of patients with the perspectives of its correction.

scholarly journals Treatment of anaerobic phlegmon of the upper extremity induced by Clostridium perfringens via application of an oxygenated pharmaceutical

2021 ◽  
pp. 107-112
Author(s):  
A.M. Gololobov ◽  
◽  
V.V. Melnikov ◽  
M.A. Topchiev ◽  
D.S. Parshin ◽  
...  
Keyword(s):  
Multiple Organ ◽  
Blood Oxygen ◽  
Multiple Organ Dysfunction ◽  
Clinical Progression ◽  
Blood Oxygen Saturation ◽  
Lethal Outcome ◽  
Pathogenetic Therapy ◽  
Positive Treatment ◽  
Surgical Tactics ◽  
Tissue Oximetry

At the present time, cases of gas infection are extremely rarely encountered. The incidence of anaerobic gas infection totals 0.1-1.0 cases in 1,000,000 of the population per year. The clinical case presented describes peculiarities in clinical progression of the disease, of its surgical and complex treatment. The dynamics of multiple organ dysfunction markers has been shown. On admission, the predicted lethal outcome rate totalled 66.7% to 82%. The treatment included local and peroral application of an oxygenated pharmaceutical. Tissue oximetry revealed elevation of blood oxygen saturation 30 and 60 minutes after the oxygenated pharmaceutical intake. The surgical tactics employed and the pathogenetic therapy combined with local and peroral application of the oxygenated pharmaceutical made it possible to achieve a positive treatment outcome

scholarly journals Prevention and treatment of progressive multiple organ disfunction in acute pancreatitis

2003 ◽  
Vol 50 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Vladimir Bumbasirevic ◽  
Miroslav Milicevic ◽  
V. Bukumirovic ◽  
Vitomir Rankovic ◽  
A. Pavlovic ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Lethal Outcome ◽  
Treatment Protocols ◽  
Course Of Illness ◽  
Improve Outcome ◽  
Prevention And Treatment

Acute pancreatitis is illness with unpredictable outcome. In some patients course of illness is progressive and leading to multiple organ dysfunction syndrome often resulting with lethal outcome. During last decade the treatment protocols have changed. Basic patophysiologic mechanisms leading to progression of the illness, as well as, contemporary diagnostic and treatment possibilities that can prevent occurrence of severe consequences and improve outcome are presented.

scholarly journals Comparison of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II and IV (APACHE) Scoring System Validity as Mortality Predictors in ICU Patients with Multiple Organ Dysfunction Syndrome in Sepsis

2021 ◽  
Vol 8 (16) ◽  
pp. 1058-1063
Author(s):  
Akshay Hiryur Manjunatha Swamy ◽  
Girish Bandigowdanahalli Kumararadhya ◽  
Srinivas Hebbal Thammaiah ◽  
Nanda Karikere Siddagangaiah ◽  
Shiva Kumar K.G
Keyword(s):  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Sofa Score ◽  
Multiple Organ ◽  
Apache Ii ◽  
Multiple Organ Dysfunction ◽  
Icu Patients ◽  
Significant Difference ◽  
The Mean ◽  
Apache Iv

BACKGROUND Multiple organ dysfunction syndrome (MODS) has recently been considered as a defining syndrome of sepsis and is responsible for a high mortality rate among the patients in the intensive care units (ICUs). Prognostication of the ICU patients is an integral part of the management of the critically ill patients and many scoring systems, for that matter, have been devised and compared for their efficiency at predicting mortality. This study was conducted to evaluate and compare the validity of sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) and APACHE IV as mortality predictors in intensive care unit (ICU) patients suffering from MODS in sepsis. METHODS Hundred patients diagnosed with MODS in sepsis were carefully examined, followed by relevant laboratory investigations. The SOFA score was calculated daily, and the APACHE II and IV scores were calculated on the day of admission. The scores were further compared among the survivors and the non-survivors, followed by receiver operating characteristic (ROC) curve analysis of the SOFA D1, D2, and D3 and the APACHE II and IV scores to estimate their capability of mortality prediction. RESULTS The means of the APACHE II, IV and SOFA D1 were 16.57 ± 6.49, 71.91 ± 16.19 and 8.75 ± 2.20, respectively. There was a statistically significant difference in the mean APACHE II scores (14.23 ± 5.20 vs. 21.12 ± 6.38) and the mean APACHE IV scores (67.27 ± 13.21 vs. 80.91 ± 17.77) in the survivors and the nonsurvivors. A statistically significant difference was also evident in the mean ages of the survivors and the non-survivors (52.82 ± 14.67 years vs. 63.25 ± 16.98 years). The SOFA score was high among the non-survivors than the survivors right from day-1 (10.24 ± 2.08 vs. 7.98 ± 1.86) to day-20 (15.00 ± 0.00 vs. 3.14 ± 0.38). Furthermore, ROC analysis showed that the best discrimination was provided by SOFA D3 followed by the APACHE II and SOFA D1 scores, with APACHE IV score showing the least. CONCLUSIONS SOFA score on day 3 provides the best mortality prediction in patients with MODS in sepsis, as compared to APACHE II and IV scores. KEYWORDS SOFA, APACHE II, APACHE IV, Multiple Organ Dysfunction Syndrome, Sepsis

COMPARISON OF APACHE II AND DAY 1 MULTIPLE ORGAN DYSFUNCTION SCORE IN CRITICALLY ILL MEDICAL PATIENTS

1999 ◽  
Vol 27 (Supplement) ◽  
pp. A53
Author(s):  
Stephen C Matchett ◽  
Jay S Cowen ◽  
Kelly E Cunningham ◽  
Kathleen M Baker ◽  
Thomas Wasser ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Multiple Organ ◽  
Apache Ii ◽  
Multiple Organ Dysfunction ◽  
Medical Patients ◽  
Multiple Organ Dysfunction Score

scholarly journals Prognostic Analysis of Elderly Patients with Multiple Organ Dysfunction Syndrome Undergoing Invasive Mechanical Ventilation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kun Xiao ◽  
Bin Liu ◽  
Wei Guan ◽  
Peng Yan ◽  
Licheng Song ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Invasive Mechanical Ventilation ◽  
The Elderly ◽  
Multiple Organ ◽  
Apache Ii ◽  
Multiple Organ Dysfunction ◽  
Saps Ii ◽  
Apache Iii

Objective. To prospectively investigate early prognostic assessments of patients with Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) who were receiving invasive mechanical ventilation (IMV). Methods. The clinical data of 351 patients were enrolled prospectively between January 2013 and January 2018. The Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE III, Simplified Acute Physiology Score (SAPS II), and Multiple Organ Dysfunction Score (MODS) were calculated. According to the outcome of 28-day, the patients were divided into survivors and nonsurvivors. Additionally, based on whether weaning could be implemented, all patients were divided into a successful-weaning group and a failure-to-wean group. Results. According to the prognosis, the areas under the receiver operating characteristic curve of the APACHE II, APACHE III, SAPS II, and MODS scoring systems were 0.837, 0.833, 0.784, and 0.860, respectively. MODS exhibited the highest sensitivity, whereas APACHE II showed the highest specificity, and successful weaning was conducive to ameliorating patients’ prognosis. Multivariate logistic regression analyses revealed that underlying lung disease, plasma albumin, serum creatinine level, number of failing organs, and IMV duration were related to prognosis of weaning, with odds ratios (ORs) of 1.447, 0.820, 1.603, 2.374, and 3.105, respectively. Conclusions. The APACHE II, APACHE III, SAPS II, and MODS systems could perform excellent prognostic assessment for patients with Multiple Organ Dysfunction Syndrome in the elderly. Underlying lung disease, plasma albumin, serum creatinine, number of failing organs, and IMV duration were independent prognostic factors of weaning in MODSE patients with invasive mechanical ventilation.

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