The Prediction of Mortality Using APACHE II Score in Patients Presenting with Peritonitis and Undergoing Emergency Exploratory Laparotomy | [Journal of Liaquat University of Medical and Health Sciences • 2024]

Author(s):

1. Hira Ashfaq: Department of Surgery, Dr.Ruth K.M Pfau CHK/DUHS, Karachi, Sindh-Pakistan.

2. Raheel Ahmed: Department of Surgery, Dr.Ruth K.M Pfau CHK/DUHS, Karachi, Sindh-Pakistan

3. Dileep Kumar: Department of Surgery, Sir Syed Medical College, Karachi, Sindh-Pakistan.

4. Erum Kazim: Department of Surgery, Dr.Ruth K.M Pfau CHK/DUHS, Karachi, Sindh-Pakistan.

5. Sundas Dastagir: Consultant, General Surgery, Karachi, Sindh-Pakistan.

6. Aisha Gul: Department of Surgery, Dr.Ruth K.M Pfau CHK/DUHS, Karachi, Sindh-Pakistan.

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.

Page(s): 21-25

DOI: 10.22442/jlumhs.2024.01051

Published: Journal: Journal of Liaquat University of Medical and Health Sciences, Volume: 23, Issue: 01, Year: 2024

Keywords:

Outcome , Peritonitis , Intensive care unit , Exploratory laparotomy , Inhospital mortality , APACHE II score

References:

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

[2] Neupane S,Koirala DP,Kharel S,Silwal S,Yadav KK. .2022 .Clinical profile and management of perforation peritonitis in Bharatpur hospital, Nepal: A prospective study. 2022 Sep, 104528 : 104528.

[3] Malik M,Iqbal M,Magsi AM,Parveen S,Khan MI,Shamim M,Malik S. .2019 .Causes of Acute Peritonitis and its Outcome in Tertiary Medical Centre. J Liaquat Uni Med Health Sci, 10(03) : 193-6.

[4] van Baal P,Morton A,Severens JL .2018 .Health care input constraints and cost-effectiveness analysis decision rules. Soc Sci Med, 01 : 59-64.

[5] Bylapudi SK,Nanjan S,Ramasamy S,Kannan A,Kantamaneni K,Nangireddi S .2021 .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, 10(12) : .

[6] Ahuja A,Pal R .2013 .Prognostic scoring indicator in evaluation of clinical outcome in intestinal perforations. J Clin Diagn Res, 10(9) : 1953-5.

[7] Kądziołka I,Świstek R,Borowska K,Tyszecki P,Serednicki W. .2019 .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, 86275(2) : 107-111.

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

[9] Yelamanchi R,Gupta N,Durga CK,Korpal M .2020 .Comparative study between P- POSSUM and Apache II scores in predicting outcomes of perforation peritonitis: Prospective observational cohort study. Int J Surg, 09 : 3-7.

[10] Tian Y,Yao Y,Zhou J,Diao X,Chen H,Cai K .2021 .Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. 2022 Jan, 744907 : 744907.

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

[12] Kulkarni SV,Naik AS,Subramanian N. .2007 .APACHEII scoring system in perforative peritonitis. Am J Surg, 01(4) : 549-52.

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

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

[15] Bassford CR,Krucien N,Ryan M,Griffiths FE,Svantesson M,Z M .2019 .Preferences for Patient Admission to ICU: Evidence From a Choice Experiment. Crit Care Med, 10(11) : 1522-1530.

[16] Oliver CM,Walker E,Giannaris S,Grocott MP,Moonesinghe SR .2015 .Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. BJA: Br J Anaesth, 10(6) : 849-60.

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

Citations

Downloads

Views