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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2018

Open Access 01-12-2018 | Research article

Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria

Authors: Matti Tolonen, Federico Coccolini, Luca Ansaloni, Massimo Sartelli, Derek J. Roberts, Jessica L. McKee, Ari Leppaniemi, Christopher J. Doig, Fausto Catena, Timothy Fabian, Craig N. Jenne, Osvaldo Chiara, Paul Kubes, Yoram Kluger, Gustavo P. Fraga, Bruno M. Pereira, Jose J. Diaz, Michael Sugrue, Ernest E. Moore, Jianan Ren, Chad G. Ball, Raul Coimbra, Elijah Dixon, Walter Biffl, Anthony MacLean, Paul B. McBeth, Juan G. Posadas-Calleja, Salomone Di Saverio, Jimmy Xiao, Andrew W. Kirkpatrick, From the Closed Or Open after Laparotomy (COOL) for Source Control in Severe Complicated Intra-Abdominal Sepsis Investigators

Published in: World Journal of Emergency Surgery | Issue 1/2018

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Abstract

Background

Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database.

Methods

All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality.

Results

Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality).

Conclusions

No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest “inclusion-criteria” to recognize patients with a high chance of mortality and ICU admission.

Trial registration

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Metadata
Title
Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria
Authors
Matti Tolonen
Federico Coccolini
Luca Ansaloni
Massimo Sartelli
Derek J. Roberts
Jessica L. McKee
Ari Leppaniemi
Christopher J. Doig
Fausto Catena
Timothy Fabian
Craig N. Jenne
Osvaldo Chiara
Paul Kubes
Yoram Kluger
Gustavo P. Fraga
Bruno M. Pereira
Jose J. Diaz
Michael Sugrue
Ernest E. Moore
Jianan Ren
Chad G. Ball
Raul Coimbra
Elijah Dixon
Walter Biffl
Anthony MacLean
Paul B. McBeth
Juan G. Posadas-Calleja
Salomone Di Saverio
Jimmy Xiao
Andrew W. Kirkpatrick
From the Closed Or Open after Laparotomy (COOL) for Source Control in Severe Complicated Intra-Abdominal Sepsis Investigators
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2018
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-018-0177-2

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