Since peritonitis carries substantial mortality and morbidity, clinical therapeutic trials are essential. Therapeutic trials for peritonitis require patients stratification.
This study attempts to evaluate the prognostic value of the acute physiology score(APS) in 443 surgical intensive care unit(S-ICU) patients(male-female ratio, 2:1; mean age, 41 years) who underwent operation for peritonitis, to determine
admission
criteria to the S-ICU and to examine its usefulness in stratifying these patients according to the source of infection, type of peritonitis, and timing of surgical intervention.
An increasing APS was associated with an increased risk of hospital death, predicted death rate(PDR=1.74APS+0.79, r2=0.63, P=0.0000), and therapeutic intervention scoring system points(TISS=0.82APS+7.44, R2=0.45, p=0.0000). The mean APS was 4.2
points
in survivors and 18.4 points in patients who died. In the patients with a APS higher than 20 points, there were no survivors. In the patients with a APS lower than 8 points, there were no deaths. Patients with the pancreas and hepatobiliary
system
as
source of peritonitis had a higher APS, TISS points, points, predicted death rate and mortality than those with the other organs as source of peritonitis. Mortality rates of localized versus generalized peritonitis were similar(8.3% vs. 6.0%,
p=0.1154),
with a slight trend toward greater APS, TISS points, PDR and hospital stay in the generalized peritonitis. Patients whose operative therapy was performed more than 48 hours after the onset of peritonitis. Patients whose operative therapy was
performed
more than 48 hours after the onset of peritonitis had a lower mortality than those who had early surgery(9.0% vs. 3.7%, p=0.0195) but there were no significant difference in APS, PDR and complication rates. There was no significant difference in
mortality between the first two years of study(January, 1989-December, 1990) and last two years(January, 1991-December, 1992).
There results suggest that APS is a reliable predictor of outcome and a useful stratification system in patients with peritonitis.
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