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01.08.2013 | Original Article

APACHE II and Mannheim Peritonitis Index (MPI) fail to predict lethality in septic peritonitis in immunosuppressed solid organ transplant recipients

verfasst von: V. Assfalg, MD, D. Reim, MD, E. Matevossian, MD, B. Holzmann, MD, K. L. Emmanuel, MD, A. Novotny, MD, N. Hüser, MD

Erschienen in: European Surgery | Ausgabe 4/2013

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Summary

Background

We investigated the applicability of both Acute Physiology And Chronic Health Evaluation II (APACHE II) and Mannheim Peritonitis Index (MPI) in transplant recipients with intestinal perforation as polymicrobial peritonitis is highly life-threatening in patients with impaired immunological defence and the course of abdominal sepsis is aberrant compared to non-immunosuppressed individuals.

Methods

In a retrospective database analysis, we validated the consistency of APACHE II and MPI in death prediction in septic peritonitis. In a matched-pair analysis we then investigated their applicability in immunosuppressed transplant recipients. The validation of the scores was performed with 125 non-immunosuppressed patients. In a matched-pair analysis 16 immunosuppressed transplant recipients were compared with 32 controls.

Results

In accordance with clinical observations, statistical analyses revealed significantly higher MPI scores in immunosuppressed transplant recipients (P = 0.0007), whereas APACHE II scores were comparable. Linear regression analysis revealed that predicted death rates derived from APACHE II and MPI differ significantly (P = 0.0344) in immunosuppressed transplant recipients compared to controls.

Conclusions

Both scores consistently serve as reliable tools for prediction of lethality in septic peritonitis but they fail in immunosuppressed organ recipients. Our findings clearly confirm that in immunosuppressed patients severe peritonitis might be present despite an a- or oligosymptomatic clinical course.

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Van Till JW, van Veen SQ, van Ruler O, et al. The innate immune response to secondary peritonitis. Shock. 2007;28(5):504–17.PubMed

Hensler T, Hecker H, Heeg K, et al. Distinct mechanisms of immunosuppression as a consequence of major surgery. Infect Immun. 1997;65(6):2283–91.PubMed

Zeitoun G, Laurent A, Rouffet F, et al. Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg. 2000;87(10):1366–74.PubMedCrossRef

Novotny A, Emmanuel K, Matevossian E, et al. Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis. Am J Surg. 2007;194(1):35–9.PubMedCrossRef

Knaus WA, Wagner DP, Draper EA, et al. APACHE III prognostic system. Risk prediction of hospital mortality for critically hospitalized adults. Chest. 1991;100:1619–36.PubMedCrossRef

Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.PubMedCrossRef

Linder MM, Wacha H, Feldmann U, et al. The Mannheim peritonitis index. An instrument for the intra-operative prognosis of peritonitis. Chirurg. 1987;58(2):84–92.PubMed

Demmel N, Muth G, Maag K, et al. Prognostic scores in peritonitis: the Mannheim Peritonitis Index or APACHE II? Langenbecks Arch Chir. 1994;379(6):347–52.PubMedCrossRef

Komatsu S, Shimomatsuya T, Nakajima M, et al. Prognostic factors and scoring system for survival in colonic perforation. Hepatogastroenterology. 2005;52(63):761–64.PubMed

10.

Bosscha K, Reijnders K, Hulstaert PF, et al. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg. 1997;84(11):1532–4.PubMedCrossRef

11.

Demmel N, Maag K, Osterholzer G. Probability of clinical prognostic factors in peritonitis – evaluation of the Mannheim Peritonitis-Index. Langenbecks Arch Chir. 1994;379:152–8.PubMedCrossRef

12.

Rix TE, Bates T. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery. World J Emerg Surg. 2007;2:16.PubMedCrossRef

13.

Rogy M, Függer R, Schemper M, et al. The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score. Chirurg. 1990;61(4):297–300.PubMed

14.

Michalak G, Kwiatkowski A, Czerwinski J, et al. Surgical complications of simultaneous pancreas-kidney transplantation: a 16-year-experience at one centre. Transpl Proc. 2005;37(8):3555–7.CrossRef

15.

Michalak G, Kwiatkowski A, Bieniasz M, et al. Infectious complications after simultaneous pancreas-kidney transplantation. Transpl Proc. 2005;37(8):3560–3.CrossRef

16.

Sansalone CV, Maione G, Aseni P, et al. Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients. Transpl Proc. 2005;37(6):2651–3.CrossRef

17.

SFAR—Société Française d’Anesthésie et de Réanimation. APACHE II and predicted mortality. http://www.sfar.org/scores2/apache22.html [accessed Oct.–Dec. 2012].

18.

Függer R, Rogy M, Herbst F, et al. Validation study of the Mannheim Peritonitis Index. Chirurg. 1988;59(9):598–601.PubMed

19.

Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg. 1994;81(2):209–13.PubMedCrossRef

20.

Nomura T, Tasaki Y, Hirata Y, et al. Intestinal perforation after cadaveric renal transplantation. Int J Urol. 2004;11(9):774–7.PubMedCrossRef

21.

Peng T, Peng MH, Li LQ, et al. Perforation after combined liver-kidney transplantation for a case of congenital polycystic disease. World J Gastroenterol. 2004;10(18):2769–71.PubMed

22.

Abderrahim E, Bouhamed L, Raies L, et al. Intestinal perforation following renal transplantation: report of 2 cases related to cytomegalovirus disease. Transpl Proc. 2003;35(7):2706–7.CrossRef

23.

Andreoni KA, Pelletier RP, Elkhammas EA, et al. Increased incidence of gastrointestinal surgical complications in renal transplant recipients with polycystic kidney disease. Transplantation. 1999;67(2):262–6.PubMedCrossRef

24.

Stelzner M, Vlahakos DV, Milford EL, et al. Colonic perforations after renal transplantation. J Am Coll Surg. 1997;184(1):63–9.PubMed

25.

Bardaxoglou E, Maddern G, Ruso L, et al. Gastrointestinal surgical emergencies following kidney transplantation. Transpl Int. 1993;6(3):148–52.PubMedCrossRef

26.

Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101(6):1481–3.PubMedCrossRef

27.

Assfalg V, Hüser N, Reim D, et al. Combined immunosuppressive and antibiotic therapy improves bacterial clearance and survival of polymicrobial septic peritonitis. Shock. 2010;33(2):155–61.PubMedCrossRef

28.

Grunau G, Heemken R, Hau T. Predictors of outcome in patients with postoperative intra-abdominal infection. Eur J Surg. 1996;162(8):619–25.PubMed

29.

Gea-Banacloche JC, Opal SM, Jorgensen J, et al. Sepsis associated with immunosuppressive medications: an evidence-based review. Crit Care Med. 2004;32:S578–90.PubMedCrossRef

30.

Soubrane O, el Meteini M, Devictor D, et al. Risk and prognostic factors of gut perforation after orthotopic liver transplantation for biliary atresia. Liver Transpl Surg. 1995;1(1):2–9.PubMedCrossRef

31.

Lee YJ, Park CH, Yun JW, et al. Predictive comparisons of procalcitonin (PCT) level, arterial ketone body ratio (AKBR), APACHE III score and multiple organ dysfunction score (MODS) in systemic inflammatory response syndrome (SIRS). Yonsei Med J. 2004;29(1):29–37.

Titel: APACHE II and Mannheim Peritonitis Index (MPI) fail to predict lethality in septic peritonitis in immunosuppressed solid organ transplant recipients
verfasst von: V. Assfalg, MD
D. Reim, MD
E. Matevossian, MD
B. Holzmann, MD
K. L. Emmanuel, MD
A. Novotny, MD
N. Hüser, MD
Publikationsdatum: 01.08.2013
Verlag: Springer Vienna
Erschienen in: European Surgery / Ausgabe 4/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-013-0218-8

Springer Medizin Österreich

Summary

Background

Methods

Results

Conclusions

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