The role of the intra-abdominal view in complicated intra-abdominal infections

Show full item record



Permalink

http://hdl.handle.net/10138/300592

Citation

World Journal of Emergency Surgery. 2019 Mar 29;14(1):15

Title: The role of the intra-abdominal view in complicated intra-abdominal infections
Author: Tolonen, Matti; Sallinen, Ville; Leppäniemi, Ari; Bäcklund, Minna; Mentula, Panu
Publisher: BioMed Central
Date: 2019-03-29
URI: http://hdl.handle.net/10138/300592
Abstract: Abstract Background The prognostic role of what a surgeon observes in the abdomen of patients with complicated intra-abdominal infection (cIAI) is largely unknown. The aim of this prospective study was to systemically analyze components of the intra-abdominal view (IAV) and their association to severe complicated intra-abdominal sepsis (SCIAS) or mortality. Methods The study cohort consisted of adult patients with cIAI. The operating surgeon filled a paper form describing the intra-abdominal view. Demographics, operative details, and preoperative physiological status were collected. Descriptive, univariate, and multivariate statistical analyses were performed, and a new score was developed based on regression coefficients. The primary outcome was a composite outcome of SCIAS or 30-day mortality, in which SCIAS was defined as organ dysfunctions requiring intensive care unit admission. Results A total of 283 patients were analyzed. The primary outcome was encountered in 71 (25%) patients. In the IAV, independent risk factors for the primary outcome were fecal or bile as exudate (odds ratio (OR) 1.98, 95% confidence interval 1.05–3.73), diffuse peritonitis (OR 2.15, 1.02–4.55), diffuse substantial redness of the peritoneum (OR 5.73, 2.12–15.44), and a non-appendiceal source of cIAI (OR 11.20, 4.11–30.54). Based on these factors, an IAV score was developed and its performance analyzed. The area under the receiver operating characteristic for the IAV score was 0.81. The IAV score also correlated significantly with several outcomes and organ dysfunctions. Conclusions The extent of peritonitis, diffuse substantial redness of the peritoneum, type of exudate, and source of infection associate independently with SCIAS or mortality. A high IAV score associates with mortality and organ dysfunctions, yet it needs further external validation. Combining components of IAV into comprehensive scoring systems for cIAI patients may provide additional value compared to the current scoring systems. Trial registration The study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database ( NCT02726932 ).
Subject: Intra-abdominal infection
Secondary peritonitis
Emergency surgery
Sepsis
Intra-abdominal view
Severe peritonitis
Rights: The Author(s).


Files in this item

Total number of downloads: Loading...

Files Size Format View
13017_2019_Article_232.pdf 966.0Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record