The Prediction of Mortality Using APACHE II Score in Patients Presenting with Peritonitis and Undergoing Emergency Exploratory Laparotomy

Authors

  • Hira Ashfaq
  • Raheel Ahmed
  • Dileep Kumar
  • Erum Kazim
  • Sundas Dastagir
  • Aisha Gul

Keywords:

Peritonitis, Exploratory laparotomy, APACHE II score, intensive care unit, outcome, in-hospital mortality

Abstract

OBJECTIVE: To Predict mortality using the APACHE II score in patients presenting with peritonitis and undergoing emergency exploratory laparotomy.

Methodology: The prospective study was conducted in Civil Hospital Karachi's surgery department from April to September 2021, with a non-probability sampling technique. A total of 84 patients of either sex between the age of 16-70 years who met the diagnostic criteria of peritonitis were included consecutively. Patients with incomplete laboratory records and uncorrectable preoperative comorbidities were excluded. The APACHE II score was categorized into three groups, and demographic details and outcomes were calculated using SPSS version 20 for the data analysis. Post-stratification Chi-square test was applied, taking a p-value of < 0.05 as statistically significant.

RESULTS: Out of 84 patients, 38 (45.2%), 37 (44%) and 09 (10.7%) had APACHE score < 10, 11-20 and ? 20 respectively. The total in-hospital mortality rate was 8.3%. In the patients with the lowest APACHE score < 10, a mortality rate of 2.6% was recorded. A mortality of 5.4% was recorded in patients with APACHE II group 2, while group 3 with APACHE II score > 20 had the highest mortality rate of 44%. The difference was statistically significant. (p=0.001).

CONCLUSION: The results of the APACHE II score obtained in patients classified them into three different groups based on the severity of conditions in patients with peritonitis, which validated the Prediction of increased mortality with higher scores.

References

Baloch I, Shaikh A, Shaikh SF. Preoperative peritoneal drainage as a part of resuscitation in severe peritonitis. J Pak Med Assoc. 2013; 63(7): 919-20.

Neupane S, Koirala DP, Kharel S, Silwal S, Yadav KK. Clinical profile and management of perforation peritonitis in Bharatpur hospital, Nepal: A prospective study. Ann Med Surg (Lond). 2022 Sep 11; 82: 104528. doi: 10.1016/j.amsu.2022.104528.

Malik M, Iqbal M, Magsi AM, Parveen S, Khan MI, Shamim M, Malik S. Causes of Acute Peritonitis and its Outcome in Tertiary Medical Centre. J Liaquat Uni Med Health Sci. 2019; 18(03): 193­6. doi: 10.22442/jlumhs.191830626

Kumar P, Singh K, Kumar A. A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation. International Surg J. 2017; 4(2): 690-6. doi: 10.18203/2349-2902.isj20170215.

van Baal P, Morton A, Severens JL. Health care input constraints and cost-effectiveness analysis decision rules. Soc Sci Med. 2018 Mar; 200: 59-64. doi: 10.1016/j.socscimed.2018.01.026.

Khan MS, Haider SA, Ashfaq A, Khan S, Shariff AH. Geospatial mapping of patients presenting for Emergency Laparotomy to a Private Sector Tertiary Care Hospital in Pakistan. J Pal Med Assoc. 2019; 69(1): S37-S40

Oliver CM, Walker E, Giannaris S, Grocott MP, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. BJA: Br J Anaesth. 2015; 115(6): 849-60. doi: 10.1093/bja/aev350. Epub 2015 Nov 3.

Bassford CR, Krucien N, Ryan M, Griffiths FE, Svantesson M, Fritz Z et al. U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment. Crit Care Med. 2019; 47(11): 1522-1530. doi: 10.1097/CCM.0000000000003903.

Nag DS, Dembla A, Mahanty PR, Kant S, Chatterjee A, Samaddar DP et al. Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. World J Clin Cases. 2019; 7(16): 2227-37. doi: 10.12998/wjcc.v7.i16.2227.

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

Haidri FR, Rizvi N, Motiani B. Role of APACHE score in predicting mortality in chest ICU. J Pak Med Assoc. 2011; 61(6): 589-92.

Kulkarni SV, Naik AS, Subramanian N. APACHE-II scoring system in perforative peritonitis. Am J Surg. 2007; 194(4): 549-52. doi: 10.1016/j.amjsurg.2007.01.031.

Akavipat P, Thinkhamrop J, Thinkhamrop B, Sriraj W. Acute Physiology And Chronic Health Evaluation (Apache) Ii Score - The Clinical Predictor In Neurosurgical Intensive Care Unit. Acta Clin Croat. 2019; 58(1): 50-56. doi: 10.20471/acc.2019.58.01.07.

Tian Y, Yao Y, Zhou J, Diao X, Chen H, Cai K et al. Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. Front Med (Lausanne). 2022 Jan 26; 8: 744907. doi: 10.3389/fmed.2021.744907.

Yelamanchi R, Gupta N, Durga CK, Korpal M. Comparative study between P- POSSUM and Apache II scores in predicting outcomes of perforation peritonitis: Prospective observational cohort study. Int J Surg. 2020; 83: 3-7. doi: 10.1016/j.ijsu.2020.09.006. Epub 2020 Sep 11.

Delibegovic S, Markovic D, Hodzic S. APACHE II scoring system is superior in the Prediction of the outcome in critically ill patients with perforative peritonitis. Med Arh. 2011; 65(2): 82-85.

K?dzio?ka I, ?wistek R, Borowska K, Tyszecki P, Serednicki W. Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiol Intensive Ther. 2019; 51(2): 107-111. doi: 10.5114/ait.2019.86275.

Ahuja A, Pal R. Prognostic scoring indicator in evaluation of clinical outcome in intestinal perforations . J Clin Diagn Res. 2013; 7(9): 1953-5. doi: 10.7860/JCDR/2013/6572.3375.

Bylapudi SK, Nanjan S, Ramasamy S, Kannan A, Kantamaneni K, Nangireddi S et al. Role of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II Score in Predicting Outcomes of Peritonitis Due to Hollow Viscous Perforation: A Prospective Observational Study. Cureus. 2021; 13(12): e20155. doi: 10.7759/cureus.20155.

JOURNAL OF LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES

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Published

03-04-2024

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1.
Ashfaq H, Ahmed R, Dileep Kumar, Kazim E, Dastagir S, Gul A. The Prediction of Mortality Using APACHE II Score in Patients Presenting with Peritonitis and Undergoing Emergency Exploratory Laparotomy. J Liaq Uni Med Health Sci [Internet]. 2024 Apr. 3 [cited 2024 Dec. 22];23(01):21-5. Available from: http://ojs.lumhs.edu.pk/index.php/jlumhs/article/view/1172

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Vol. 23 No. 01 (2024): Journal of Liaquat University of Medical & Health Sciences

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