PMID- 17826077
OWN - NLM
STAT- MEDLINE
DCOM- 20071002
LR  - 20090520
IS  - 1879-1883 (Electronic)
IS  - 0002-9610 (Linking)
VI  - 194
IP  - 4
DP  - 2007 Oct
TI  - APACHE-II scoring system in perforative peritonitis.
PG  - 549-52
AB  - BACKGROUND: Prospective assessment of the Acute Physiology and Chronic Health 
      Evaluation-II (APACHE-II) scoring system of stratification of disease severity 
      has been shown to provide objective discrimination between low-risk and high-risk 
      groups of patients with intra-abdominal sepsis. The current study was undertaken 
      to evaluate the performance of APACHE-II score in prediction of mortality risk in 
      patients with peritonitis due to hollow viscus perforation. STUDY DESIGN: Fifty 
      patients admitted to a teaching hospital with peritonitis due to hollow viscus 
      perforation were prospectively studied over a 2-year period. APACHE-II points 
      were assigned to all patients in order to calculate their individual risk of 
      mortality before undergoing emergency surgery. The accuracy in outcome prediction 
      of the APACHE-II system was assessed by means of receiver operating 
      characteristic (ROC) curve and the Pearson correlation coefficient and its 
      significance test. RESULTS: Of the 50 patients admitted during the study period, 
      there were 42 (84%) survivors and 8 (16%) nonsurvivors. Mean APACHE-II score of 
      the study population was 11.38 with a range of 1 to 23. The predicted death rate 
      was 23% and the observed death rate was 16%. Mean APACHE-II score in survivors 
      was 9.88, whereas in nonsurvivors it was 19.25. Using ROC analysis, the area 
      under the curve was found to be .984. Correlation of APACHE-II score and 
      predicted death rate showed perfect correlation, with r = .99 and P <.001 [R2 = 
      .9993]. APACHE-II score between 11 and 15 showed a sensitivity and specificity of 
      100% and 73.8%, respectively, and APACHE-II score of 16 to 20 had a sensitivity 
      and specificity of 87.5% and 100%, respectively. CONCLUSION: APACHE-II score 
      between 11 and 20 was shown to be a better predictor of risk of mortality in 
      patients with peritonitis due to hollow viscus perforation. Predicted mortality 
      did not correlate with observed mortality in patients with APACHE-II scores of 1 
      to 10 and greater than 20. The APACHE-II scoring system can be used to assess 
      group outcomes in patients with peritonitis due to hollow viscus perforation. 
      However, it does not provide sufficient confidence for outcome prediction in 
      individual patients.
FAU - Kulkarni, Srikanth V
AU  - Kulkarni SV
AD  - Department of General Surgery, M.S. Ramaiah Medical College and Teaching 
      Hospital, Bangalore-560 054 Karnataka, India.
FAU - Naik, Anitha S
AU  - Naik AS
FAU - Subramanian, Nirmala Jr
AU  - Subramanian N Jr
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Surg
JT  - American journal of surgery
JID - 0370473
SB  - IM
MH  - *APACHE
MH  - Adult
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peritonitis/etiology/*mortality
MH  - Risk Assessment
MH  - Rupture, Spontaneous
EDAT- 2007/09/11 09:00
MHDA- 2007/10/03 09:00
CRDT- 2007/09/11 09:00
PHST- 2006/07/23 00:00 [received]
PHST- 2007/01/20 00:00 [revised]
PHST- 2007/01/20 00:00 [accepted]
PHST- 2007/09/11 09:00 [pubmed]
PHST- 2007/10/03 09:00 [medline]
PHST- 2007/09/11 09:00 [entrez]
AID - S0002-9610(07)00548-X [pii]
AID - 10.1016/j.amjsurg.2007.01.031 [doi]
PST - ppublish
SO  - Am J Surg. 2007 Oct;194(4):549-52. doi: 10.1016/j.amjsurg.2007.01.031.