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dc.contributor.authorTolonen, M.
dc.contributor.authorCoccolini, F.
dc.contributor.authorAnsaloni, L.
dc.date.accessioned2019-06-21T18:46:32Z
dc.date.available2019-06-21T18:46:32Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85045010046&doi=10.1186%2fs13017-018-0177-2&partnerID=40&md5=4a56c8a72a1bb9101022723455e342ee
dc.identifier.urihttp://hdl.handle.net/10713/9768
dc.description.abstractBackground Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database. Methods All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality. Results Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality). Conclusions No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest “inclusion-criteria” to recognize patients with a high chance of mortality and ICU admission. Copyright 2018 The Author(s).en_US
dc.description.urihttps://dx.doi.org/10.1186/s13017-018-0177-2en_US
dc.language.isoen-USen_US
dc.publisherBioMed Central Ltd.en_US
dc.relation.ispartofWorld Journal of Emergency Surgery
dc.subjectEpidemiologyen_US
dc.subjectIntra-abdominal sepsisen_US
dc.subjectOrgan dysfunctionen_US
dc.subjectRandomized controlled trialen_US
dc.subjectRisk stratificationen_US
dc.subjectSeptic shocken_US
dc.subjectTrial methodologyen_US
dc.titleGetting the invite list right: A discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteriaen_US
dc.typeArticleen_US
dc.identifier.doi10.1186/s13017-018-0177-2
dc.identifier.pmid29636790


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