Risk factors for therapeutic failure in the management of post-operative peritonitis: a <i>post hoc</i> analysis of the DURAPOP trial

Montravers, Philippe; Esposito-Farèse, Marina; Lasocki, Sigismond; Grall, Nathalie; Veber, Benoît; Eloy, Philippine; Séguin, Philippe; Weiss, Emmanuel; Dupont, Hervé; Bronchard, Régis; Desmard, Mathieu; Levrard, Mélanie; Mahjoub, Yazine; Gergaud, Soizic; Gaillard, Thomas; Plantefève, Gaëtan; Pajot, Olivier; Blasco, Gilles; Samain, Emmanuel; Besch, Guillaume; Pily-Floury, Sebastien; Paugam, Catherine; Pease, Sebastien; Abback, Paer; Girard, Claude; Payen, Jean‐François; Hérault, Marie-Christine; Jaber, Sami; Jung, Boris; Delay, J; Gally, Josette; Meistelman, Claude; Perrier, Jean‐François; Asehnoune, Karim; Cinotti, Raphaël; Tesnière, Antoine; Mignon, Alexandre; Lescot, Thomas; Belhadj-Tahar, Nouria; Beaussier, Marc; Lepape, Alain; Piriou, Vincent; Wallet, Florent; Tassin, Candice; Cousson, J.; Raclot, P.; Floch, Thierry; Launey, Yoann; Gouin, Philippe; Clavier, Thomas; Auboyer, C.; Collanges, Olivier; Georger, Jean-François

doi:10.1093/jac/dkab307

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…The most frequently stated comorbidities which significantly worsen the prognosis of patients are age, gender, malignancy, presurgical organ failure, chronic renal disease, cardiovascular disease, and diabetes mellitus [6,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of comorbidities in patients with diffuse peritonitis

et al. 2022

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Summary Background Diffuse peritonitis is a severe disease with high mortality and morbidity rates. Therapy is fundamentally surgical. It is important to identify patients with a significantly worse prognosis and patients who may benefit from more aggressive surgical and postsurgical care such as NPWT (Narrow Pressure Wound Therapy) prior to surgery. We tried to identify a determining factor for higher morbidity and mortality rates resulting in a worse prognosis among initial data and patient comorbidities in order to focus therapy towards more aggressive surgical management. Methods In a group of 274 patients with diffuse peritonitis, we evaluated the type of peritonitis according to effusion, origin, surgery type, and the age, gender, and present comorbidities of the patients, and compared it with the overall mortality, morbidity rate, and duration of hospitalization. Results Patients without comorbidities had a significantly lower burden in both morbidity and mortality. We recorded the highest difference in mortality in patients with two or more comorbidities, with pulmonary and cardiovascular diseases, with malignancy and hypertension. Morbidity was found to be significantly exacerbated by the presence of two or more severe diseases, cardiovascular disease, malignancy, and hypertension. Conclusion We identified age, effusion type, and the presence of comorbidities as key factors for the prognosis of our patients—the morbidity and mortality rates were substantially increased in patients with two or more comorbidities, as well as by the presence of cardiovascular disease, malignancy, and hypertension. A more aggressive approach should be considered to improve the prognosis in these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of comorbidities in patients with diffuse peritonitis

et al. 2022

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“…Доведена роль таких факторів ризику перитоніту як вік, ниркова недостатність, цукро-вий діабет, панкреатит та гнійний характер ексудату, особливо за наявністю Klebsiella spp. [6].…”

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Risk Factors of Severe Peritonitis in Surgical Patients

Karol,

Bilyaeva

2023

Med. Sci. of Ukr.

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Background. Radical changes in clinical practice along with the introduction of new surgical interventions and the new concept of precision medicine justify the need to update the traditional scales for assessing the condition of patients with peritonitis. Aim: to establish risk factors for the development of peritonitis in patients who were operated on for acute diseases of the abdominal cavity. Material and methods. The study involved 139 patients who were operated on for acute diseases of the abdominal cavity, among whom 71 had acute appendicitis, 51 had acute cholecystitis, 10 had a perforated stomach or duodenal ulcer, others had perforation of a tumor or small intestine, a pinched hernia, cryptogenic peritonitis. Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: 1st group - 1-3 points (63 people, 45.3%) and 2nd group - 4 or more points (76 people, 54.7%).Statistical processing of the research results was carried out using the EZR v.1.54 program (graphical user interface for R statistical software version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). Results. Comparison of study groups showed that the more severe course of peritonitis was more common in men, had a greater prevalence, fibrous and purulent nature of the exudate, and was more often in the toxic stage. Patients of the second group were 6.5 years older (p=0.029), stayed longer in the hospital (by 2 days; p=0.002) and had a longer duration of surgery (by 25 minutes; p<0.001), a higher body temperature during hospitalization (by 0.4oC; p=0.008), which normalized one day later (p<0.001), as well as a lower ptrothrombin index (PTI) with higher values of international normalized ratio (INR) and prothrombin time (p<0.05), higher leukocytosis (p<0.001) and erythrocyte sedimentation rate (p=0.042) in comparison with the patients of the first group. Univariante regression analysis confirmed a positive effect on the risk of severe peritonitis of age, male gender, body temperature, pulse rate, EMN, and leukocytosis, and a negative effect of PTI value. Conclusion. The following risk factors for severe peritonitis were identified: male sex and age, higher temperature at hospitalization and heart rate, higher PTI and INR, as well as higher leukocytosis.

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Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Pascale

Deschepper²,

Blot³

et al. 2022

Intensive Care Med

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PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS ) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs . 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

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Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

Cited by 5 publications

References 24 publications

Prognostic significance of comorbidities in patients with diffuse peritonitis

Prognostic significance of comorbidities in patients with diffuse peritonitis

Risk Factors of Severe Peritonitis in Surgical Patients

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

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