Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: A WSES observational study

Massimo Sartelli, Fikri M. Abu-Zidan, Francesco M. Labricciosa, Yoram Kluger, Federico Coccolini, Luca Ansaloni, Ari Leppäniemi, Andrew W. Kirkpatrick, Matti Tolonen, Cristian Tranà, Jean Marc Regimbeau, Timothy Hardcastle, Renol M. Koshy, Ashraf Abbas, Ulaş Aday, A. R.K. Adesunkanmi, Adesina Ajibade, Lali Akhmeteli, Emrah Akln, Nezih AkkapuluAlhenouf Alotaibi, Fatih Altintoprak, Dimitrios Anyfantakis, Boyko Atanasov, Goran Augustin, Constança Azevedo, Miklosh Bala, Dimitrios Balalis, Oussama Baraket, Suman Baral, Or Barkai, Marcelo Beltran, Roberto Bini, Konstantinos Bouliaris, Ana B. Caballero, Valentin Calu, Marco Catani, Marco Ceresoli, Vasileios Charalampakis, Asri Che Jusoh, Massimo Chiarugi, Nicola Cillara, Raquel Cobos Cuesta, Luigi Cobuccio, Gianfranco Cocorullo, Elif Colak, Luigi Conti, Yunfeng Cui, Belinda De Simone, Samir Delibegovic, Zaza Demetrashvili, Demetrios Demetriades, Ana Dimova, Agron Dogjani, Mushira Enani, Federica Farina, Francesco Ferrara, Domitilla Foghetti, Tommaso Fontana, Gustavo P. Fraga, Mahir Gachabayov, Grelpois Gérard, Wagih Ghnnam, Teresa Giménez Maurel, Georgios Gkiokas, Carlos A. Gomes, Ali Guner, Sanjay Gupta, Andreas Hecker, Elcio S. Hirano, Adrien Hodonou, Martin Hutan, Igor Ilaschuk, Orestis Ioannidis, Arda Isik, Georgy Ivakhov, Sumita Jain, Mantas Jokubauskas, Aleksandar Karamarkovic, Robin Kaushik, Jakub Kenig, Vladimir Khokha, Denis Khokha, Jae Il Kim, Victor Kong, Dimitris Korkolis, Vitor F. Kruger, Ashok Kshirsagar, Romeo Lages Simões, Andrea Lanaia, Konstantinos Lasithiotakis, Pedro Leão, Miguel León Arellano, Holger Listle, Andrey Litvin, Aintzane Lizarazu Pérez, Eudaldo Lopez-Tomassetti Fernandez, Eftychios Lostoridis, Davide Luppi, Gustavo M. Machain V, Piotr Major, Dimitrios Manatakis, Marianne Marchini Reitz, Athanasios Marinis, Daniele Marrelli, Aleix Martínez-Pérez, Sanjay Marwah, Michael McFarlane, Mirza Mesic, Cristian Mesina, Nickos Michalopoulos, Evangelos Misiakos, Felipe Gonçalves Moreira, Ouadii Mouaqit, Ali Muhtaroglu, Noel Naidoo, Ionut Negoi, Zane Nikitina, Ioannis Nikolopoulos, Gabriela Elisa Nita, Savino Occhionorelli, Iyiade Olaoye, Carlos A. Ordoñez, Zeynep Ozkan, Ajay Pal, Gian M. Palini, Kyriaki Papageorgiou, Dimitris Papagoras, Francesco Pata, Michał Pȩdziwiatr, Jorge Pereira, Gerson A. Pereira Junior, Gennaro Perrone, Tadeja Pintar, Magdalena Pisarska, Oleksandr Plehutsa, Mauro Podda, Gaetano Poillucci, Martha Quiodettis, Tuba Rahim, Daniel Rios-Cruz, Gabriel Rodrigues, Dmytry Rozov, Boris Sakakushev, Ibrahima Sall, Alexander Sazhin, Miguel Semião, Taanya Sharda, Vishal Shelat, Giovanni Sinibaldi, Dmitrijs Skicko, Matej Skrovina, Dimitrios Stamatiou, Marco Stella, Marcin Strzałka, Ruslan Sydorchuk, Ricardo A. Teixeira Gonsaga, Joel Noutakdie Tochie, Gia Tomadze, Lara Ugoletti, Jan Ulrych, Toomas Ümarik, Mustafa Y. Uzunoglu, Alin Vasilescu, Osborne Vaz, Andras Vereczkei, Nutu Vlad, Maciej Walȩdziak, Ali I. Yahya, Omer Yalkin, Tonguç U. Yilmaz, Ali Ekrem Ünal, Kuo Ching Yuan, Sanoop K. Zachariah, Justas Žilinskas, Maurizio Zizzo, Vittoria Pattonieri, Gian Luca Baiocchi, Fausto Catena

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Original languageEnglish
Article number34
JournalWorld Journal of Emergency Surgery
Volume14
Issue number1
DOIs
Publication statusPublished - Jul 15 2019

    Fingerprint

Keywords

  • Acute peritonitis
  • Early warning score
  • Emergency surgery
  • Source control
  • Abdomen/abnormalities
  • Prognosis
  • Hospital Mortality
  • Humans
  • Middle Aged
  • Risk Factors
  • Logistic Models
  • Male
  • Chi-Square Distribution
  • Sepsis/diagnosis
  • Injury Severity Score
  • Adult
  • Female
  • Aged

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine

Cite this

Sartelli, M., Abu-Zidan, F. M., Labricciosa, F. M., Kluger, Y., Coccolini, F., Ansaloni, L., Leppäniemi, A., Kirkpatrick, A. W., Tolonen, M., Tranà, C., Regimbeau, J. M., Hardcastle, T., Koshy, R. M., Abbas, A., Aday, U., Adesunkanmi, A. R. K., Ajibade, A., Akhmeteli, L., Akln, E., ... Catena, F. (2019). Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: A WSES observational study. World Journal of Emergency Surgery, 14(1), [34]. https://doi.org/10.1186/s13017-019-0253-2