Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria
| Autor: | Raul Coimbra, Federico Coccolini, Anthony R. MacLean, Ernest E. Moore, Christopher J. Doig, Matti Tolonen, Ari Leppäniemi, Fausto Catena, Craig N. Jenne, Elijah Dixon, Jessica L. McKee, Paul Kubes, Walter L. Biffl, Derek J. Roberts, Bruno M. Pereira, Osvaldo Chiara, Gustavo Pereira Fraga, Jose J. Diaz, Andrew W. Kirkpatrick, Yoram Kluger, Timothy C. Fabian, Paul B. McBeth, Juan G. Posadas-Calleja, Luca Ansaloni, Massimo Sartelli, Jianan Ren, Michael Sugrue, Chad G. Ball, Salomone Di Saverio, Jimmy Xiao |
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| Přispěvatelé: | Faculty of Medicine, II kirurgian klinikka, Department of Surgery, Clinicum, HUS Abdominal Center |
| Rok vydání: | 2018 |
| Předmět: |
Male
INTENSIVE-CARE-UNIT ACUTE-PANCREATITIS Organ Dysfunction Scores Epidemiology Organ dysfunction 030230 surgery law.invention Trial methodology Injury Severity Score 0302 clinical medicine law Septic shock HOSPITAL MORTALITY 80 and over Prospective Studies 10. No inequality Finland APACHE Randomized Controlled Trials as Topic Aged 80 and over APACHE II lcsh:Medical emergencies. Critical care. Intensive care. First aid Middle Aged Prognosis Intensive care unit 3. Good health Randomized controlled trial Emergency Medicine Female SOFA score medicine.symptom ORGAN FAILURE Research Article medicine.medical_specialty SEPTIC SHOCK SEPSIS-3 PRIMARY FASCIAL CLOSURE lcsh:Surgery Peritonitis Intra-abdominal sepsis Risk stratification Aged Humans Length of Stay Patient Participation ROC Curve Retrospective Studies Sepsis Patient Selection SECONDARY PERITONITIS 03 medical and health sciences Internal medicine medicine DAMAGE-CONTROL LAPAROTOMY business.industry INTERNATIONAL CONSENSUS DEFINITIONS 030208 emergency & critical care medicine lcsh:RD1-811 lcsh:RC86-88.9 medicine.disease 3126 Surgery anesthesiology intensive care radiology Appendicitis ABDOMINAL SEPSIS Surgery business |
| Zdroj: | World Journal of Emergency Surgery, Vol 13, Iss 1, Pp 1-11 (2018) World Journal of Emergency Surgery : WJES |
| Popis: | Background Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database. Methods All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality. Results Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality). Conclusions No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest “inclusion-criteria” to recognize patients with a high chance of mortality and ICU admission. Trial registration https://clinicaltrials.gov/ct2/show/NCT03163095; Registered on May 22, 2017. |
| Databáze: | OpenAIRE |
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