| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 28
| Issue : 2 | Page : 123-128 |
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Effectiveness of acute physiology and chronic health Evaluation-II scoring in predicting outcomes of perforation peritonitis
Goutham P Sathyapal, Alex Oommen
Department of General Surgery, Government Medical College, Kozhikode, Kerala, India
Correspondence Address:
Dr. Goutham P Sathyapal
Poovathumkandi House, Panniyankara Kallai Post, Kozhikode - 670 003, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ksj.ksj_43_22
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Introduction: Several scoring systems have been developed for predicting the severity and outcomes of peritonitis, such as the Acute Physiology and Chronic Health Evaluation (APACHE-II) score, Ranson's score and Mannheim's peritonitis index. The aim of the study was to evaluate the performance of the APACHE-II scoring system in predicting mortality and morbidity in patients with perforation peritonitis. Methods: Diagnostic test evaluation was done from June 2020 to December 2021, including 168 patients with hollow viscous perforation, excluding appendicular abscess perforation, who attended the casualty and underwent surgery. Data were collected by meticulous history, clinical examination, radiological, histopathological and serological investigation, operative findings and follow-up till discharge or death. The outcome of the study is based on an analysis of mortality and morbidity due to perforation peritonitis and its correlation with the scores obtained based on APACHE-2 scoring system. Results: The commonest age group of perforation peritonitis was 41–50 years of age (21.4%), with male preponderance. The most common site of perforation was gastric in all age groups, and the most common aetiology was peptic ulcer, followed by malignancy. The mortality rate was 10.7%, and the rates are higher for females, older age groups, and malignancies. There was a statistically significant association for APACHE-II score in predicting the mortality, complications and morbidity associated with perforation peritonitis. The average APACHE-II score in this study was 6.17 and the average score among survivors was 4.33 and non-survivors 21.44. Morbidity and mortality increased as the score increased; a score above 15 had a sensitivity of 99% and specificity of 94.4% in predicting mortality, the complication rates were more in scores above 10. The low-risk categories (0–5 and 6–10) had a favourable outcome in terms of morbidity and mortality. Conclusions: The mean age was 46.6 years with male preponderance. The most common aetiology was peptic ulcer perforation, followed by perforation due to malignancies and site of perforation being the stomach, followed by colon. There was a statistically significant association for APACHE-II score in predicting the mortality, complications and morbidity associated with perforation peritonitis and score above 15 has a sensitivity of 99% and a specificity of 94.4% in predicting mortality associated with secondary peritonitis.
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