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Type: Artigo
Title: Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study: a WSES observational study
Author: Sartelli, Massimo
Abu-Zidan, Fikri M.
Labricciosa, Francesco M.
Kluger, Yoram
Coccolini, Federico
Ansaloni, Luca
Leppaniemi, Ari
Kirkpatrick, Andrew W.
Tolonen, Matti
Trana, Cristian
Regimbeau, Jean-Marc
Hardcastle, Timothy
Koshy, Renol M.
Abstract: Background: 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. Methods: 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. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate >= 22 breaths/min, systolic blood pressure < 100mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO(2)) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4mmol/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. Conclusions: 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.
Subject: Peritonite
Country: Reino Unido
Editor: BioMed Central
Rights: Aberto
Identifier DOI: 10.1186/s13017-019-0253-2
Date Issue: 2019
Appears in Collections:FCM - Artigos e Outros Documentos

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