Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)

Abstract

BackgroundTo validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.MethodsThe WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18–99) were enrolled in the WISS study.ResultsUnivariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4.ConclusionsWSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Open versus laparoscopic approach in the treatment of abdominal emergencies in elderly population

“…As known, the CO 2 pneumoperitoneum tends to induce alterations on acid-base balance, blood gas balance and cardiovascular and pulmonary physiology, severe septic state (30). Most of these changes should not result in clinical significance but in elderly patients with comorbid conditions they could evolve in decreased cardiopulmonary reserve and moreover in patients with severe cardiopulmonary disease the hypercarbia could lead to significant acidosis (6, 7).…”

Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit

“…(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The pitfalls of this disease are the doubtful diagnosis in its early stage in which it can be mimicking different digestive diseases, even functional, (23)(24)(25)(26)(27) and, subsequently, a possible evolution in severe peritonitis and sepsis (28)(29)(30)(31). As a consequence, although the appendectomy is considered a simple and safe procedure, a reliable diagnosis and a safe and correct surgical procedure are needed (32).…”

Laparoscopic ileocecal resection in acute and chronic presentations of Crohn�s disease. A single center experience

“…Older patients had usually more post-operative morbidity and mortality in CD, mostly related to preexisting conditions; if possible in these patients the treatment should be medical (19)(20)(21). Surgery if necessary should be the most conservative possible and laparoscopy allowing early recovery could reduce the post-operative sequelae also in elderlies if no contraindications to the pneumoperitoneum exist.…”