Severity Scoring Systems for Prognosis and Efficacy of Polymyxin B-Immobilized Fiber Treatment for Colonic Perforation |
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Authors: | Shuhei Komatsu Takumi Shimomatsuya Masayuki Nakajima Susumu Ono Kazuhiro Maruhashi |
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Institution: | (1) Department of Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan;(2) Department of Emergency and Critical Care Center, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan;(3) Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan |
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Abstract: | Purpose There is no established system for predicting prognosis and evaluating the efficacy of antiseptic treatments such as polymyxin
B-immobilized fiber (PMX) according to the severity of peritonitis in patients with colonic perforation. We investigated the
predictive value of various severity scoring systems for survival and for the efficacy of antiseptic treatments, to identify
high-risk patients.
Methods We reviewed 26 consecutive patients who underwent emergency operations between 1996 and 2003 for colorectal perforation not
caused by trauma or iatrogenic disease. Several severity scores, i.e., Acute Physiology and Chronic Health Evaluation II (APACHE
II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) were calculated
and analyzed as predictive scoring systems for prognosis, survival and efficacy of PMX treatment.
Results An APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related
to a poor prognosis. With or without PMX treatment, an APACHE II score of 15 or less, a SOFA score of 7 or less, an MPI score
of 27 or less, and an MOF score of 7 or less were all related to a good prognosis. Conversely, all patients died when the
severity scoring points were higher than 20 in APACHE II, higher than 12 in SOFA, and higher than 39 in MPI. When PMX treatment
was given to patients with an intermediate score, no correlation between survival and its efficacy was found, except in the
MOF scoring system.
Conclusion These severity scoring systems can assist with the prediction of prognosis. They may also be useful for determining if PMX
treatment would be unnecessary or ineffective in certain patients. However, the optimal application of PMX treatment in selected
patients according to the severity scoring systems needs further investigation.
This study was presented at the 104th Annual Congress of the Japan Surgical Society, Osaka, Japan, April 7–9, 2004. |
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Keywords: | Colonic perforation Severity scoring system Sepsis Polymyxin B-immobilized fiber Endotoxin |
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