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Abstract：
Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.
This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.
A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.
The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.
A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.
The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
摘要：
腹膜源控制的时机和充分性是急性腹膜炎患者管理中最重要的支柱。因此,急性腹膜炎的早期预后评估对于评估严重程度并建立及时和适当的治疗至关重要。这项研究的目的是确定急性腹膜炎患者住院死亡率的临床和实验室预测因素，并开发一个警告评分系统。基于易于识别和评估的变量，全球接受。
这项全球多中心观察性研究在2018年2月1日至2018年5月31日的4个月研究期间，包括56个国家的153个外科部门。
共纳入3137名患者，1815名(57.9%)男性和1322名(42.1%)女性，年龄中位数为47岁（四分位间距[IQR]28-66）。整体住院死亡率为8.9%,中位住院时间为6天（IQR4-10）。使用多变量逻辑回归，确定了与住院死亡率相关的独立变量：年龄>80岁，恶性肿瘤，严重的心血管疾病，严重的慢性肾病,呼吸频率≥22次呼吸/分钟，收缩压<100mmHg，AVPU响应量表（语音和无响应），空气中血氧饱和度(SpO2)<90%,血小板计数<50,000个细胞/mm3，乳酸>4mmol/l。这些变量用于创建PIPAS严重性评分，急性腹膜炎患者的床边预警评分。0-1分患者的总死亡率为2.9％，2-3分患者的总死亡率为22.7％，4-5分患者的总死亡率为46.8％，7-8分患者的总死亡率为86.7％。
简单的PIPAS严重程度评分可以在全球范围内使用，可以帮助临床医生识别治疗失败和死亡的高风险患者。
这项全球多中心观察性研究在2018年2月1日至2018年5月31日的4个月研究期间，包括56个国家的153个外科部门。
共纳入3137名患者，1815名(57.9%)男性和1322名(42.1%)女性，年龄中位数为47岁（四分位间距[IQR]28-66）。整体住院死亡率为8.9%,中位住院时间为6天（IQR4-10）。使用多变量逻辑回归，确定了与住院死亡率相关的独立变量：年龄>80岁，恶性肿瘤，严重的心血管疾病，严重的慢性肾病,呼吸频率≥22次呼吸/分钟，收缩压<100mmHg，AVPU响应量表（语音和无响应），空气中血氧饱和度(SpO2)<90%,血小板计数<50,000个细胞/mm3，乳酸>4mmol/l。这些变量用于创建PIPAS严重性评分，急性腹膜炎患者的床边预警评分。0-1分患者的总死亡率为2.9％，2-3分患者的总死亡率为22.7％，4-5分患者的总死亡率为46.8％，7-8分患者的总死亡率为86.7％。
简单的PIPAS严重程度评分可以在全球范围内使用，可以帮助临床医生识别治疗失败和死亡的高风险患者。
