scholarly journals Application of APACHE II Score in assessing the severity and outcome in peritonitis due to hollow viscus perforation

2019 ◽  
Vol 6 (3) ◽  
pp. 940
Author(s):  
M. Venkat Reddy ◽  
T. Amarsimha Reddy ◽  
Satyadev . ◽  
B. RaghuRam Teja ◽  
P. ShanmugaRaju
Keyword(s):  
Apache Ii ◽  
Individual Risk ◽  
Apache Ii Score ◽  
Hollow Viscus ◽  
Prospective Survey ◽  
Generalized Peritonitis ◽  
Risk Of Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hollow Viscus Perforation

Background: Acute generalized peritonitis from Gastrointestinal hollow viscus perforation is a potentially life threatening condition. The aim of the study was to assess the application of APACHE II score in assessing the severity and outcome in peritonitis due to hollow viscus perforation and to correlate morbidity and mortality patterns using the modified APACHE II Score and its significance on the outcome.Methods: A prospective survey of 50 patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards, CAIMS, Karimnagar. APACHE-II scores were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery.Results: Total 50 patients were admitted during the study period. Age and sex distribution shows that perforation was common >60 years in our study. Higher modified APACHE II scores statistically influenced mortality in all the patients irrespective of aetiology with p<0.001 which is statistically significant.Conclusions: Modified APACHE II scoring predicts mortality which was significant irrespective of the aetiology.

scholarly journals A prospective study of Mannheim peritonitis index as a prognostic scale in analysis of outcome in hollow viscus perforation

2018 ◽  
Vol 5 (4) ◽  
pp. 1306
Author(s):  
Abhilash Gautham Ramesh ◽  
Kshama S. Ramesh
Keyword(s):  
Prognostic Index ◽  
Apache Ii Score ◽  
Hollow Viscus ◽  
Mannheim Peritonitis Index ◽  
Surgical Infection ◽  
Generalized Peritonitis ◽  
Reliable Marker ◽  
Intra Abdominal Infection ◽  
A Prospective Study ◽  
Hollow Viscus Perforation

Background: MPI as a prognostic index helps in analysis of prognosis in peritonitis in hollow viscus perforation. The factors that are considered in MPI index are routinely used in assessment of surgical patients, they are easily available, routinely performed, and helps in arrival at a prognosis in fast and effective way.Methods: A prospective survey of patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards of our institute during the period starting from January 2014 to December 2015. Study population consisted of 150 consecutive patients with performative peritonitis, which confirmed on emergency laparotomy.Results: The Mannheim peritonitis index emerged as a reliable marker for assessing the severity and prognosis of intra-abdominal infection with sensitivity and specificity comparable to APACHE II score which has been adopted as the gold standard by Surgical Infection Society. The score designed specifically for peritonitis, combines preoperative and operative data and is easy to apply. MPI scores were consistent with low scores among survivors and higher scores among non-survivors.Conclusions: MPI scores in the analysis were sharp predictor of mortality.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

scholarly journals Evaluation of Mannheim’s Peritonitis Index in Prediction of Mortality in Patients with Non-traumatic Hollow Viscus Perforation Peritonitis

2021 ◽  
Vol 19 (1) ◽  
pp. 179-184
Author(s):  
Vikal Chandra Shakya ◽  
Anang Pangeni ◽  
Saurav Karki ◽  
Lokesh Raj Sharma
Keyword(s):  
Univariate Analysis ◽  
Individual Risk ◽  
P Value ◽  
Diffuse Peritonitis ◽  
Hollow Viscus ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality ◽  
Perforation Peritonitis ◽  
Hollow Viscus Perforation

Background: Hollow viscus perforation peritonitis is one of the commonest surgical emergencies with high mortality and morbidity. The objective of this study was to evaluate the effectiveness of Mannheim’s peritonitis index in prediction of mortality in these patients.Methods: This is a retrospective, observational cohort study in these patients managed in a single-center from January 1, 2013 to December 30, 2019. Total index scores were plotted in the receiver operating characteristic curves to find out the cut-off point. Sensitivity, specificity, relative risk, positive and negative predictive values were calculated. The individual risk factors were analyzed for mortality as well.Results: Case records of 395 cases of non-traumatic hollow viscus perforation peritonitis were available, there were 33 mortalities (8.2%), mean score was 22.96 (+7.6) points (range 10-43 points). The sensitivity and specificity with score cut-off of 25 came to be 75.8% and 56.35%; positive and negative predictive value being 13.7% and 96.2%. Risk of patients for mortality with scores >25 was 3.62 times those with scores <25 for mortality. Mortality rate was 2.4% with scores <21, 8.9% with 21–29 and 20.9% with >29 respectively (p-value <0.05). Univariate analysis showed age >50 years, presence of organ dysfunction, diffuse peritonitis, non-colonic origin and character of exudates were significant factors; multivariate analysis showed only organ failure as significant.Conclusions: Mannheim peritonitis index is very useful in stratification of severity of the disease and prediction of mortality in patients with peritonitis, and should be included in management of all these patients.Keywords: Mannheim’s peritonitis index; perforation peritonitis

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

2020 ◽  
pp. 089686082097085
Author(s):  
Watanyu Parapiboon ◽  
Thosapol Chumsungnern ◽  
Treechada Chamradpan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Intermittent Hemodialysis ◽  
Risk Of Death ◽  
Risk Of Mortality

Background: Literature regarding the outcomes of lower dosage peritoneal dialysis (PD) in treating acute kidney injury (AKI) among resource-limited setting is sparse. This study aims to compare the risk of mortality in patients with AKI receiving lower PD dosage and conventional intermittent hemodialysis (IHD) in Thailand. Methods: In a tertiary center in Thailand, a matched case–control study using propensity scores in patients with AKI was conducted to compare the outcomes between lower PD dosage (18 L per day for first two sessions, weekly Kt/ V 2.2) and IHD (three times a week) from February 2015 to January 2016. The primary outcome was a 30-day in-hospital mortality rate. Secondary outcomes included dialysis dependence at 90 days. Results: Eighty-four patients were included (28 PD and 56 IHD). Patient characteristics were comparable between two treatment groups. Overall, the mean age was 58 years. Most of the patients were critically ill (87% need mechanical ventilator; mean acute physiological and chronic health evaluation (APACHE II) score: 25). The 30-day in-hospital mortality rate was similar between the PD and IHD patients (57% vs. 46%, p = 0.36). The dialysis dependence rate was also comparable at 90 days. The risk of death among AKI patients was higher in those with respiratory failure, higher APACHE II score, and starting dialysis with blood urea nitrogen greater than 70 mg dL−1. Conclusion: Clinical outcomes, including risk of mortality and 90-day dialysis dependence among patients with AKI, appear to be comparable between lower dosage PD and IHD.

Acute generalized peritonitis in adult African patients: Assessment of severity using APACHE II score

2003 ◽  
Vol 7 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Abdul Rashid K. Adesunkanmi ◽  
Tajudeen A. Badmus ◽  
E. Augustine Agbakwuru ◽  
Akinwumi B. Ogunronbi
Keyword(s):  
Apache Ii ◽  
Apache Ii Score ◽  
Generalized Peritonitis ◽  
African Patients

scholarly journals Non-traumatic ruptured splenic abscess presenting with pneumoperitoneum in an immunocompetent patient: a diagnostic dilemma

2019 ◽  
Vol 12 (5) ◽  
pp. e228961
Author(s):  
Nitin Agarwal ◽  
Ashish Sharma ◽  
Gaurav Garg
Keyword(s):  
Differential Diagnosis ◽  
Splenic Abscess ◽  
Immunocompetent Patient ◽  
Clinical Entity ◽  
Immunocompromised Patients ◽  
Diagnostic Dilemma ◽  
Hollow Viscus ◽  
Life Threatening ◽  
Perforation Peritonitis ◽  
Hollow Viscus Perforation

Splenic abscess is a rare life-threatening clinical entity. There are only a handful of reported cases of spontaneous splenic abscess rupture with pneumoperitoneum. Rupture of splenic abscess associated with gas-producing pathogens may lead to pneumoperitoneum. We hereby report the case of a ruptured splenic abscess with pneumoperitoneum in a young immunocompetent woman masquerading as hollow viscus perforation peritonitis. Ruptured splenic abscess should be kept in mind for treating surgeons as a differential diagnosis of pneumoperitoneum or peritonitis, particularly for immunocompromised patients.

scholarly journals A prospective study of prediction of outcomes in perforative peritonitis using apache II scoring system

2017 ◽  
Vol 4 (8) ◽  
pp. 2648
Author(s):  
Rajinder Singh ◽  
Harprit Kaur Madan ◽  
Sandeep H. Tayade
Keyword(s):  
Scoring System ◽  
Death Rate ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Perforative Peritonitis ◽  
A Prospective Study

Background: To predict the risk of mortality and morbidity in patients with perforative peritonitis using APACHE II scoring system. To evaluate the usefulness of APACHE II scoring system as a potential clinical and research tool which could be included as routine part of patient assessment in institution like ours.Methods: This was a prospective, observational study of prediction of outcomes in 80 patients of perforative peritonitis using APACHE II scoring system, conducted during the period of 2 years at our tertiary care institute.Results: Predicted death rate of the study was 17.31% and observed death rate was 25%. However, when observed and predicted death rates were compared in group of patients with APACHE II score of <10, it was over estimating the mortality. In group of patients with APACHE II score 11-20 and >20 it was underestimating the mortality. About 71.2% patients came under APACHE II score <10 with mortality of 3.5%. 23.7% came under group of patients with APACHE II score of 11-20 with mortality of 73.6% and only 5% patients had score >20 with 100% mortality were seen amongst them.Conclusions: In the present study, APACHE II scoring system was found to be accurate predictor of group outcome and can be effectively used in prediction of group outcome in similar population, but does not give sufficient confidence for outcome in an individual patient.

scholarly journals High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

2020 ◽  
Author(s):  
Philipp Schultz ◽  
Elke Schwier ◽  
Claas Eickmeyer ◽  
Dietrich Henzler ◽  
Thomas Koehler
Keyword(s):  
Septic Shock ◽  
Blood Purification ◽  
Apache Ii ◽  
University Hospital ◽  
Apache Ii Score ◽  
Optimal Timing ◽  
High Dose ◽  
Applied Dose ◽  
Life Threatening ◽  
Physiologic Parameters

Abstract Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood purified was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was significantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood purified was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identified 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood purification volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough.

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