Introducing a new severity classification of complicated intra-abdominal infections

Abstract text (incl. references and figure legends)

Introduction

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

Material and methods

The retrospective analysis involved 116 patients admitted to the Department of Surgical Diseases (DSD) at a University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora and operated on for cIAIs between January 2017 and August 2021. We created three groups of severity according to 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 and WSES SSS < 8), severe cIAIs (SOFA ≥ 2 and WSES SSS < 8) and severe complicated intra-abdominal sepsis (SCIAS) – WSES SSS ≥ 8. Different laboratory markers, clinical parameters and scoring systems were compared and analyzed between the severity groups.

Results

The established overall in-hospital mortality was 25%. Among patients with mild cIAIs death rate was 5.6%, in severe cIAIs group – 24.5% and in SCIAS group we observed the highest mortality rate – 48.4%. Variables that differed significantly according to severity were age, systolic blood pressure, heart rate, respiratory rate, altered mental status, C-reactive protein levels, quick-SOFA score, SOFA score, Mannheim Peritonitis Index and WSES SSS.

Conclusion

The proposed severity classification of cIAIs was shown as useful and reliable for predictive assessment of each patient. We believe this new severity classification could assist surgeons and intensivists in treatment and evaluation of cIAIs if accepted

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