ПРОГНОЗ ИСХОДА ВТОРИЧНОГО ПЕРИТОНИТА

Objectives. To develop a new system for predicting the outcome of secondary peritonitis and analyze its accuracy in comparison with the most common analogous systems. Methods. The study is based on the analysis of treatment results in patients (n=352) with secondary peritonitis. At admission sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) persons. There were the following main causes of death in the mortality structure: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). The efficacy of the Mantheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors were analyzed. The likelihood of the effect of 85 clinical and laboratory parameters on the outcome of patients with secondary peritonitis using nonparametric methods of statistical research (Fisher’s test, Mann-Whitney test, Chi-square with Yates correction) have been analyzed. Criteria predictively associated with lethal outcome (p <0.05) were selected, they were included in the PPS scale. To compare the predictive value of peritonitis prediction systems, ROC analysis was used with the construction of ROC curves for each of the systems. Results. The most important criteria in predicting fatal outcome are the patient’s age, the presence of malignant tumor, the exudate nature, sepsis (septic shock), and also polyorganic insufficiency which is not associated with developed peritonitis. To assess the prognostic value of peritonitis prediction systems, ROC curve analysis was used. The greatest accuracy in terms of predicting mortality in patients with generalized secondary peritonitis is possessed by PPS (AUC 0.942), minimal - APACHEII (AUC 0.840). Conclusion. APACHEII, MPI, WSESSSS and PPS systems can be considered as reliable in predicting mortality in patients with peritonitis. The greatest accuracy in predicting fatal outcome in patients with generalized secondary peritonitis had PPS (94%). What this paper adds An original system for predicting the outcome of peritonitis (PPS) has been developed. It was found that the criteria of the patient’s age, the presence of a malignant neoplasm, the nature of the exudate, sepsis (septic shock), as well as polyorganic insufficiency not associated with the developed peritonitis are of the greatest importance in predicting the death outcome. When conducting a comparative assessment with the most common similar systems (MPI, WSES SSS, APACHE-II), it was found that the most accurate in terms of predicting mortality in a patient with generalized secondary peritonitis is the PPS (AUC 0.942), the minimum - APACHEII (AUC 0.840).Цель. Разработать новую систему прогноза исхода вторичного перитонита и проанализировать её точность в сравнении с наиболее распространенными аналогичными системами. Материал и методы. Исследование основано на анализе результатов лечения 352 пациентов со вторичным распространенным перитонитом. Сепсис при поступлении диагностирован у 15 (4,3%) пациентов, септический шок - у 4 (1,1%). В структуре летальности основными причинами смерти были гнойная интоксикация и/или сепсис - 51 наблюдение (87,9%), раковая интоксикация - 4 (6,9%) наблюдения, острая сердечно-сосудистая недостаточность - 3 (5,2%). Анализировали эффективность Мангеймского перитонеального индекса (МPI), WSES SSS, шкалы APACHE II, оценки gSOFA, а также систему прогноза перитонита, (СПП) разработанную авторами. Нами была проанализирована вероятность влияния 85 клинических и лабораторных показателей на исход пациентов с вторичным перитонитом, с помощью непараметрических методов статистического исследования (тест Фишера, Манна-Уитни, хи-квадрат с поправкой Йейтса). Были отобраны критерии, прогностически связанные с летальным исходом (p