DEVELOPING A SEVERITY CLASSIFICATION OF COMPLICATED INTRA-ABDOMINAL INFECTIONS

Abstract

Objective

To date no severity classification of complicated intra-abdominal infections (cIAIs) is accepted in everyday practice. We aimed to present such classification in order to improve prognostic evaluation of patients with cIAIs.

Methods

This was a single-center study conducted at a University Hospital Stara Zagora including 140 patients with cIAIs. Retrospectively for the period January 2017 – October 2018 we created three groups of severity according to preoperative calculated sequential organ failure assessment (SOFA) score and World Society of Emergency Surgery Sepsis Severity Score  (WSES SSS) of each patient – mild cIAIs (SOFA < 2 points), severe cIAIs (SOFA ≥ 2) and severe complicated intra-abdominal sepsis (SCIAS) – WSES SSS ≥ 8 or septic shock. Prospectively we validated the created classification in 62 patients with cIAIs between November 2018 and August 2021.  

Results

For the retrospective and prospective group, respectively, death rate among patients with mild cIAIs was 3.1% and 3.6%, with severe cIAIs – 26.8% and 19%, and with SCIAS we observed the highest mortality – 68.8% and 30.8%. Prognostic scores that differed significantly according to severity for both time periods were SOFA, Mannheim Peritonitis Index and WSES SSS.

Conclusion

The proposed severity classification of cIAIs could be useful and reliable for predictive assessment of each patient.