The Grade–Response Relation between Severity of Peritonitis and Serum Cytokine Concentrations Explains Mannheim Peritonitis Index Threshold

Bracho-Riquelme, Rodolfo Leonel; Reyes-Romero, Miguel Arturo; Torres-Valenzuela, Alejandro; Flores-García, A.I.

doi:10.1089/sur.2009.013

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Reports on any association of APACHE II scores and mortality remain controversial. 13,32,[36][37][38] In our study, we found higher mortality among patients with APACHE II scores .11.…”

Section: Discussionsupporting

confidence: 51%

“…This result was consistent with other reports. 12,[27][28][29] Bracho-Riquelme and colleagues 13 reported that MPI scores greater 26 were associated with increased mortality. In our series, we also found significantly increased mortality in association with MPI scores over 26.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative antibiotic treatment continued for 7 to 10 days. Patients were grouped according to presentation time: ,24 versus .24 hours 11,12 ; age, ,60 versus .60 years; APACHE II score, ,11 versus .11 11 ; MPI, ,26 versus .26 13 ; and perforation width, ,0.5 versus 0.5 to 1 cm. 14,15 Open surgery was performed on all patients.…”

Section: Methodsmentioning

confidence: 99%

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Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

Çiftçi

Erözgen

2018

International Surgery

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Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI ( P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [ P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

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“…Reports on any association of APACHE II scores and mortality remain controversial. 13,32,[36][37][38] In our study, we found higher mortality among patients with APACHE II scores .11.…”

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

Çiftçi

Erözgen

2018

International Surgery

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“…It is a simple scoring system, widely used, and is specific to peritonitis. With this index, the grade-response relation between severity of peritonitis and the concentration of key regulatory serum cytokines has been demonstrated [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Leptin and leptin receptor polymorphisms are associated with poor outcome (death) in patients with non-appendicular secondary peritonitis

et al. 2011

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IntroductionLeptin (LEP) and its receptor (LEPR) participate in the immunological response during infection. LEP serum levels rise during sepsis. In patients with peritonitis, an insufficient elevation in serum LEP is associated with an increased risk of death. As gene variants of LEP and LEPR have been associated with diverse pathologic conditions, we explored the association of genetic polymorphisms of LEP or LEPR with death in patients with secondary peritonitis.MethodsA case control study was undertaken. LEP Gene -2548G > A and the LEPR Gene 223A > G polymorphism were determined in 74 patients. The odds ratio of genotype and allele distribution in survival (control) versus death (case) among patients was calculated. Serum LEP, interleukin (IL)-6, tumour necrosis factor alpha, C-reactive protein (C-RP), IL-10 and IL-13 levels were analyzed in 34 patients.ResultsThere were significant differences in genotype and allele distribution between survivors and non-survivors for -2548G > A and 223A > G polymorphisms. The presence of the mutant allele A, in -2548, had an odds ratio of 4.64 (95% CI 1.22, 17.67) with significance (P = 0.017) in the risk of death. The presence of mutant allele G, in 223, had an odds ratio of 3.57 (95% CI 1.06, 12.01) with significance in the risk of death (P = 0.033). The presence of allele A in the -2548 polymorphism was associated with differences in serum LEP (P = 0.013), and IL-10 (P = 0.0001). The presence of allele G in 223 polymorphism was likewise correlated with differences in serum LEP (P < 0001), C-RP (P = 0.033), and IL-10 (P = 0.043).ConclusionsThe polymorphisms studied are associated with death in patients with peritonitis of non-appendicular origin. This association is stronger than many known risk-factors related to peritonitis severity, and is independent of body mass. The physiopathologic mechanism is possibly related to an insufficient increase in the elevation of serum LEP levels, and is unrelated to body mass.

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“…17 Moreover, a series of cytokines related to SIRS, including CRP, TNF-α and IL-6, which are also called proinflammatory factors are blamed for the process of BT. 18…”

Section: Discussionmentioning

confidence: 99%

The Influence of Carbon Dioxide Pneumoperitoneum on Systemic Inflammatory Response Syndrome and Bacterial Translocation in Patients With Bacterial Peritonitis Caused by Acute Appendicitis

et al. 2017

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The Grade–Response Relation between Severity of Peritonitis and Serum Cytokine Concentrations Explains Mannheim Peritonitis Index Threshold

Abstract: Around the mean value of grade II peritonitis, the equilibrium between pro-inflammatory and anti-inflammatory cytokines is lost. This change coincides with the 26-point threshold for the MPI.

Cited by 5 publications

References 18 publications

Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

Leptin and leptin receptor polymorphisms are associated with poor outcome (death) in patients with non-appendicular secondary peritonitis

The Influence of Carbon Dioxide Pneumoperitoneum on Systemic Inflammatory Response Syndrome and Bacterial Translocation in Patients With Bacterial Peritonitis Caused by Acute Appendicitis

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