Evaluation of Prognostic Scoring Systems in the Prediction of the Outcome in Critically Ill Patients with Perforative Peritonitis

Background: Patients with perforative peritonitis are among the most complex cases encountered in surgical practice. Early prognostic evaluation of these patients is desirable in order to make the correct therapeutic plan, selecting highly risky patients for less aggressive surgical procedures. Prospective evaluation of different prognostic scoring systems was performed in order to assess the possibility of prediction of outcome in these patients. Patients and methods: The prospective study of 145 patients with perforative peritonitis was performed. The main outcome of this study was peritonitis-related death. Variables necessary for calculation of the scoring systems were recorded at the initial admission to the hospital (during the first 24 hours) and the third and seventh day of hospitalization, except Mannheim Peritonitis Index, which was calculated during the first 24 hours after hospitalization, i.e. during laparatomy. Sensitivity and specificity are graphically shown for the different values of cut-off points. Results: ROC curve for TISS -28 and APACHE II is significantly more accurate in comparison with other scores. The area under the curve for the first postoperative day was 0.87 for TISS-28 score, 0.86 for APACHE II score, 0.83 for MOF, 0.83 for SAPS I, 0.72 for MPI score, 0.70 for Sepsis score. In addition, this discriminatory ability remained on the third and seventh postoperative day as well. The highest rate of correlation between the observed and the expected mortality rate was in APACHE II system, for the first (Kendall’s τ correlation 0.964) and the third (Kendall’s τ correlation 0.8l0) day. There was a decrease in the rate of correlation on the seventh day for all scoring systems except for MOF score. Conclusion: APACHE II is better in prediction of the outcome to other tested scoring systems.