Prediction Of Outcome Of Patients With Perforative Peritonitis On The Basis Of Apache Iii Scoring System

Abstract

Background & Objectives: This was a prospective study to predict the outcome of patients with perforative peritonitis on the basis of APACHE III scoring system. Methods: This study consists of 100 selected cases patients admitted with features suggestive of perforative peritonitis condition in B.L.D.E.U s Shri.B.M.Patil Medical College, Hospital and Research Centre, Vijayapur from October 2014 to June 2016. All the patients were assigned APACHE III scoring system. Results: In this study mortality rate was 21%. Highest mortality was in the age group of 51-60(30.83%). Lowest mortality (1) is seen in age group of 21-30years, In this study mortality increased with increasing age. In this study mortality was observed more among male sex (17.9%), Indicating male sex is a prognostic factor. The most common diagnosis in this study was duodenal perforation (29.4%). All patients were divided into 3 groups with scores <60,31-60 and >60. Mortality was 4% in patients with score<30, mortality was 5.4% in patients with score 30-60, and mortality was 47% in patients with score >60. In this study mortality was observed more among patients with higher APACHE III score >60. Mean duration of hospital stay in this study was 12.3 among non-survivors and 18.3 days among survivors. Most common postoperative complication in this study among patients with higher APACHE III score was wound infection (23%) followed by burst abdomen (18%), septicemia (11%) and fecal fistula (8%). Patients with higher APACHE III score in this study had lesser duration of stay in hospital due tomortality and more risk of postoperative complications. Mean APACHE III score among non-survivors was 56.6 and among survivors were 50.4. Using ROC analysis the area under curve was found to be 0.955 correlation of APACHE III score and predicted death rate showed perfect correlation in patients with score <60. (P <. 001).In patients with score >60 observed death rate was higher than predicted death rate in this study. Interpretation and Conclusion: Patients with lower APCHE III scores have more favorable prognosis than patientswith higherAPCHE III score.Patients with higher APACHE III score had more risk of postoperative complications. In patients with higher APACHE III score>60, predicted mortality did not correlate with observed hospital mortality in this study. Thus it was concluded from this study that APACHE III score was reliable in predicting mortality for patients with score < 60.And APACHE III score, as measured before the treatment of perforation peritonitis correlates significantly with the outcome of disease in respect to both morbidity and mortality.