Risk Factors of Severe Peritonitis in Surgical Patients

Abstract

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.

Dynamics of indicators of oxidant-antioxidant reactions in the postoperative period in patients with disseminated peritonitis

“…Тоді як місцева хірургічна тактика при перфораціях органів черевної порожнини є досить висвітленою, системної терапії для контролю подальшої системної запальної відповіді недостатньо. Удосконалення інтенсивної терапії сприяє поліпшенню результатів лікування вторинного перитоніту, однак завданням клініцистів є встановлення діагнозу та оцінювання обох методів лікування, які потребують не лише корекції первинної патології (контроль джерела) [4,9], але й оцінювання відповіді пацієнта та відповідної підтримки функцій органів і лікування сепсису [3].…”