Skip to main content Skip to main navigation menu Skip to site footer

Comparative study of SOFA, WSESSSS, and CPIRO scoring systems as mortality predictors in a patient with complicated intra-abdominal infection

  • Gigih Laksamana Nugraha ,
  • Denny Septarendra ,
  • Tomy Lesmana ,


Abstract

Background: A widespread intra-abdominal organ infection or complicated intra-abdominal infection (cIAI) causes localized peritonitis, intra-abdominal abscess, and diffuse peritonitis. Patients suffer from morbidity and mortality as a result of this condition. Sepsis indicators such as SOFA, WSESSSS, and CPIRO scores were predictors of mortality in cIAI patients. We aimed to examine the performance of WSESSSS, CPIRO, and SOFA scoring systems to predict mortality in patients with cIAI.

Methods: A retrospective cohort, analytic observational study was conducted to assess differences in SOFA, WSESSSS, and CPIRO scoring systems' sensitivity, specificity, and accuracy as predictors of death during treatment in cIAI patients in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 265 patients were evaluated. The optimal cutoff for SOFA was score 5 with sensitivity, specificity, PPV, NPV, and accuracy of 77.2%, 87.9%, 77.2%, 87.9%, and 84.2%, respectively. The optimal cutoff for WSESSSS was score 8 with sensitivity, specificity, PPV, NPV, and accuracy of 83.7%, 82.7%, 72.0%, 90.5%, and 83.0%, respectively.  The optimal cutoff for CPIRO was 4 with sensitivity, specificity, PPV, NPV, and accuracy values of 62.0%, 90.2%, 77.0%, 81.7%, and 80.4%, respectively. Patients with high scores had a higher percentage of being hospitalized longer and cost higher than patients with a low score.

Conclusion: The SOFA, WSESSSS, and CPIRO scoring systems had comparable performance in predicting mortality in patients with cIAI. Considering the performance of WSESSSS, the use of WSESSSS alone may be sufficient enough to predict the outcome of patients with cIAI in Indonesia.

Keywords: SOFA score WSESSSS score CPIRO score predictors of mortality cIAI

References

  1. Blot S, Antonelli M, Arvaniti K, et al. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project. Intensive Care Med. 2019;45(12):1703-1717. doi:10.1007/s00134-019-05819-3.
  2. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study). World J Emerg Surg. 2013;8(1):1. Published 2013 Jan 3. doi:10.1186/1749-7922-8-1.
  3. Budipramana VS, Meilita M. Obstructive-Type Jaundice without Bile Duct Dilatation in Generalized Peritonitis Is a Specific Sign of Spontaneous Gall Bladder Perforation. Case Rep Med. 2020;2020:6504260. Published 2020 Sep 22. doi:10.1155/2020/6504260.
  4. Utariani A, Prasetyo B, Nugraha J. Correlation between the Use of Albumin Infusion and Concentrations of Serum Albumin, Proinflammatory Cytokines TNF-alpha, IL6) and SOFA Score in Septic Patients. Folia Medica Indones. 2017;(52)4. p310-315. https://doi.org/10.20473/fmi.v52i4.5481.
  5. Hecker A, Reichert M, Reuß CJ, et al. Intra-abdominal sepsis: new definitions and current clinical standards. Langenbecks Arch Surg. 2019;404(3):257-271. doi:10.1007/s00423-019-01752-7.
  6. Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study. World J Emerg Surg. 2012;7(1):36. Published 2012 Nov 29. doi:10.1186/1749-7922-7-36.
  7. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010;5:9. Published 2010 Mar 19. doi:10.1186/1749-7922-5-9.
  8. Weledji EP, Ngowe MN. The challenge of intra-abdominal sepsis. Int J Surg. 2013;11(4):290-295. doi:10.1016/j.ijsu.2013.02.021.
  9. Lalisang TJM, Usman N, Hendrawidjaya I, et al. Clinical Practice Guidelines in Complicated Intra-Abdominal Infection 2018: An Indonesian Perspective. Surg Infect (Larchmt). 2019;20(1):83-90. doi:10.1089/sur.2018.120.
  10. Budipramana VS. Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation. FMI. 2021;55(1). p43–47. https://doi.org/10.20473/fmi.v55i1.24386.
  11. Su YJ, Liao SC, Cheng BC, Hwang JC, Chen JB. Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients. BMC Nephrol. 2013;14:185. Published 2013 Sep 4. doi:10.1186/1471-2369-14-185.
  12. Abdel-Kader S, Sartelli M, Abu-Zidan FM. Complicated intra-abdominal infections: a prospective validation study of the WSES Sepsis Severity Score. Singapore Med J. 2019;60(6):317-321. doi:10.11622/smedj.2018120.
  13. Mwenda KI, Ojuka DK, Awori MN. Utility of World Society of Emergency Surgery Sepsis Severity Score in Predicting Outcomes of Intra-abdominal Infections. Ann African Surg. 2020;(17)2. p65–68. DOI: 10.4314/aas.v17i2.5.
  14. Posadas-Calleja JG, Stelfox HT, Ferland A, et al. Derivation of a PIRO Score for Prediction of Mortality in Surgical Patients With Intra-Abdominal Sepsis. Am J Crit Care. 2018;27(4):287-294. doi:10.4037/ajcc2018576.
  15. Tolonen M, Coccolini F, Ansaloni L, et al. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria. World J Emerg Surg. 2018;13:17. Published 2018 Apr 6. doi:10.1186/s13017-018-0177-2.
  16. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-710. doi:10.1007/BF01709751.
  17. Coccolini F, Trevisan M, Montori G, et al. Mortality Rate and Antibiotic Resistance in Complicated Diverticulitis: Report of 272 Consecutive Patients Worldwide: A Prospective Cohort Study. Surg Infect (Larchmt). 2017;18(6):716-721. doi:10.1089/sur.2016.283.
  18. Kidwai R, Sharma A. Acute Perforated Appendicitis: Clinical Profile and Analysis of Risk Factors. J Nepalgunj Med Coll. 2018;(16)2. p13–15. DOI: https://doi.org/10.3126/jngmc.v16i2.24865.
  19. Hameed T, Kumar A, Sahni S, Bhatia R, Vidhyarthy AK. Emerging Spectrum of Perforation Peritonitis in Developing World. Front Surg. 2020;7:50. Published 2020 Sep 15. doi:10.3389/fsurg.2020.00050.
  20. Nakamura F, Yui R, Muratsu A, et al. Study of the prognostic factor of the colon perforation case with the pan-peritonitis that needed emergency surgery: a single-center observational study. Acute Med Surg. 2019;6(4):379-384. Published 2019 Jun 6. doi:10.1002/ams2.429.
  21. Sverdén E, Agréus L, Dunn JM, Lagergren J. Peptic ulcer disease. BMJ. 2019;367:l5495. Published 2019 Oct 2. doi:10.1136/bmj.l5495.
  22. Zhu C, Badach J, Lin A, et al. Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate. Am J Surg. 2021;221(5):935-941. doi:10.1016/j.amjsurg.2020.07.039.
  23. Doohan D, Rezkitha YAA, Waskito LA, Yamaoka Y, Miftahussurur M. Helicobacter pylori BabA-SabA Key Roles in the Adherence Phase: The Synergic Mechanism for Successful Colonization and Disease Development. Toxins (Basel). 2021;13(7):485. Published 2021 Jul 13. doi:10.3390/toxins13070485.
  24. Martin-Loeches I, Timsit JF, Leone M, et al. Clinical controversies in abdominal sepsis. Insights for critical care settings. J Crit Care. 2019;53:53-58. doi:10.1016/j.jcrc.2019.05.023.
  25. Azuhata T, Kinoshita K, Kawano D, et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care. 2014;18(3):R87. Published 2014 May 2. doi:10.1186/cc13854.
  26. Bloos F, Thomas-Rüddel D, Rüddel H, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014;18(2):R42. Published 2014 Mar 3. doi:10.1186/cc13755.
  27. Dong Y, Zhou H, Li M, et al. A novel simple scoring model for predicting severity of patients with SARS-CoV-2 infection. Transbound Emerg Dis. 2020;67(6):2823-2829. doi:10.1111/tbed.13651.
  28. Karakike E, Kyriazopoulou E, Tsangaris I, Routsi C, Vincent JL, Giamarellos-Bourboulis EJ. The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort. Crit Care. 2019;23(1):387. Published 2019 Nov 29. doi:10.1186/s13054-019-2665-5.
  29. Yang Z, Hu Q, Huang F, Xiong S, Sun Y. The prognostic value of the SOFA score in patients with COVID-19: A retrospective, observational study. Medicine (Baltimore). 2021;100(32):e26900. doi:10.1097/MD.0000000000026900.
  30. Kao AM, Cetrulo LN, Baimas-George MR, et al. Outcomes of open abdomen versus primary closure following emergent laparotomy for suspected secondary peritonitis: A propensity-matched analysis. J Trauma Acute Care Surg. 2019;87(3):623-629. doi:10.1097/TA.0000000000002345.
  31. Niu B, Kim B, Limketkai BN, et al. Mortality from Spontaneous Bacterial Peritonitis Among Hospitalized Patients in the USA. Dig Dis Sci. 2018;63(5):1327-1333. doi:10.1007/s10620-018-4990-y.

How to Cite

Nugraha, G. L., Septarendra, D., & Lesmana, T. (2022). Comparative study of SOFA, WSESSSS, and CPIRO scoring systems as mortality predictors in a patient with complicated intra-abdominal infection. Bali Medical Journal, 11(3), 1397–1403. https://doi.org/10.15562/bmj.v11i3.3523
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
4

Total
2

Share

Search Panel

Gigih Laksamana Nugraha
Google Scholar
Pubmed
BMJ Journal

Denny Septarendra
Google Scholar
Pubmed
BMJ Journal

Tomy Lesmana
Google Scholar
Pubmed
BMJ Journal