Secondary peritonitis natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
With treatment, patients usually do well. Without treatment, the outcome is usually poor. However, in some cases, patients do poorly even with prompt and appropriate treatment.
Natural History
Prognosis
Peritonitis is a frequent cause of morbidity.The prognosis greatly depends on the degree of intra-abdominal contamination, the severity of underlying disease, the immune response of the host and associated organ dysfunction.[1] Associated mortality rates vary from < 1% to > 60% Factors affecting prognosis are:
- Age
- Blood pressure
- Cause of infection
- Site of origin of peritonitis
- Number of organs involved in multi-organ-failure (MOF)
- Pre-operative organ failure
- Presence of metabolic acidosis
- Serum albumin
- New York Heart Association cardiac function status
- Malnutrition
- Malignoma
- Fecal peritonitis
- Immunosuppression
The prognosis risk of peritonitis may be stratified using the Mannheim's Peritoneal index score (MPI) as shown below:[2][3]
| Riskfactor | Score |
|---|---|
| Age >50 years | 5 |
| Female sex | 5 |
| Organ failure | 7 |
| Malignancy | 4 |
| Origin of sepsis not colonic | 4 |
| Diffuse generalized peritonitis | 6 |
| Preoperative duration of peritonitis >24h | 4 |
Intraperitoneal exudates
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Assessment of the prognosis of patients with peritonitis using MPI
- For a score of 27, the sensitivity was 66.67%, specificity was 100%, and positive predictive value for mortality is 100% at an accuracy of 94%.[2]
| Assessment of severity of peritonitis using MPI | ||
| Score | Mortality rate | Morbidity rate |
|---|---|---|
| <21 | 0% | 13.33% |
| 21-27 | 27.28% | 65.71% |
| >27 | 100% | 100% |
Factors that were found to be independently significant factors in predicting the mortality:
- Duration of pain for >24 h
- Organ failure on admission
- Female sex and
- Feculent exudate
- Early prognostic evaluation of abdominal sepsis is useful in the assessment of the severity of the disease and to select high-risk patients for early surgical reintervention.
References
- ↑ Mulier, Stefaan; Penninckx, Freddy; Verwaest, Charles; Filez, Ludo; Aerts, Raymond; Fieuws, Steffen; Lauwers, Peter (2003). "Factors Affecting Mortality in Generalized Postoperative Peritonitis: Multivariate Analysis in 96 Patients". World Journal of Surgery. 27 (4): 379–384. doi:10.1007/s00268-002-6705-x. ISSN 0364-2313.
- ↑ 2.0 2.1 Sharma S, Singh S, Makkar N, Kumar A, Sandhu MS (2016). "Assessment of Severity of Peritonitis Using Mannheim Peritonitis Index". Niger J Surg. 22 (2): 118–122. doi:10.4103/1117-6806.189009. PMC 5013738. PMID 27843277.
- ↑ Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D; et al. (1996). "Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients". Arch Surg. 131 (6): 641–5. PMID 8645072.