Intensive Care Medicine

, Volume 40, Issue 2, pp 202–210 | Cite as

Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort

  • Ascanio Tridente
  • Geraldine M. Clarke
  • A. Walden
  • S. McKechnie
  • P. Hutton
  • G. H. Mills
  • A. C. Gordon
  • P. A. H. Holloway
  • J.-D. Chiche
  • J. Bion
  • F. Stuber
  • C. Garrard
  • C. J. Hinds
  • GenOSept Investigators



Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis admitted to ICUs across Europe. Here we report an epidemiological survey of the subset of patients with FP.


To define the clinical characteristics, outcomes and risk factors for mortality in patients with FP admitted to ICUs across Europe.


Data was extracted from electronic case report forms. Phenotypic data was recorded using a detailed, quality-assured clinical database. The primary outcome measure was 6-month mortality. Patients were followed for 6 months. Kaplan–Meier analysis was used to determine mortality rates. Cox proportional hazards regression analysis was employed to identify independent risk factors for mortality.


Data for 977 FP patients admitted to 102 centres across 16 countries between 29 September 2005 and 5 January 2011 was extracted. The median age was 69.2 years (IQR 58.3–77.1), with a male preponderance (54.3 %). The most common causes of FP were perforated diverticular disease (32.1 %) and surgical anastomotic breakdown (31.1 %). The ICU mortality rate at 28 days was 19.1 %, increasing to 31.6 % at 6 months. The cause of FP, pre-existing co-morbidities and time from estimated onset of symptoms to surgery did not impact on survival. The strongest independent risk factors associated with an increased rate of death at 6 months included age, higher APACHE II score, acute renal and cardiovascular dysfunction within 1 week of admission to ICU, hypothermia, lower haematocrit and bradycardia on day 1 of ICU stay.


In this large cohort of patients admitted to European ICUs with FP the 6 month mortality was 31.6 %. The most consistent predictors of mortality across all time points were increased age, development of acute renal dysfunction during the first week of admission, lower haematocrit and hypothermia on day 1 of ICU admission.


Faecal peritonitis ICU outcome GenOSept Sepsis Septic shock Genetic epidemiology 

Supplementary material

134_2013_3158_MOESM1_ESM.doc (1.2 mb)
Supplementary material 1 (DOC 1248 kb)


  1. 1.
    Baron MJ, Kasper DL (2011) Intraabdominal infections and abscesses. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J (eds) Harrison’s principles of internal medicine. McGraw-Hill, New YorkGoogle Scholar
  2. 2.
    Calandra T, Cohen J (2005) The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33:1538–1548PubMedCrossRefGoogle Scholar
  3. 3.
    Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRefGoogle Scholar
  4. 4.
    Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D, Crucitti F (1996) Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg 131:641–645PubMedCrossRefGoogle Scholar
  5. 5.
    Koperna T, Schulz F (2000) Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg 24:32–37PubMedCrossRefGoogle Scholar
  6. 6.
    Ohmann C, Wittmann DH, Wacha H (1993) Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group. Eur J Surg 159:267–274PubMedGoogle Scholar
  7. 7.
    Demmel N, Maag K, Osterholzer G (1994) Wertigkeit klinischer parameter zur prognosebeurteilung der peritonitis—Validierung des Mannheimer Peritonitis-Index [Probability of clinical prognostic factors in peritonitis—evaluation of the Mannheim Peritonitis-Index]. Langenbecks Archiv für Chirurgie 379:152–158PubMedCrossRefGoogle Scholar
  8. 8.
    Billing A, Frohlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 81:209–213PubMedCrossRefGoogle Scholar
  9. 9.
    van Ruler O, Kiewiet J, Boer K, Lamme B, Gouma D, Boermeester M, Reitsma J (2011) Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surg 11:1–9CrossRefGoogle Scholar
  10. 10.
    Singh R, Kumar N, Bhattacharya A, Vajifdar H (2011) Preoperative predictors of mortality in adult patients with perforation. Indian J Crit Care Med 15:157–163PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    van Ruler O, Mahler C, Boer K, Reuland E, Gooszen H, Opmeer B, de Graaf P, Lamme B, Gerhards M, Steller E, van Till J, de Borgie C, Gouma D, Reitsma J, Boermeester M, Group DPS (2007) Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 298:865–872PubMedCrossRefGoogle Scholar
  12. 12.
    Pawa N, Jadidi M, Konarzewski W, Tutton MG, Motson RW (2009) Outcome of faecal peritonitis admissions to a critical care unit: an 18-year analysis. In: Abstracts of the Association of Coloproctology of Great Britain and Ireland annual meeting, vol 11, no 5, pp 1462–8910Google Scholar
  13. 13.
    Sayer J, Simpson G, McCrossan L, Welters I (2012) Outcome of faecal peritonitis in the ICU. Crit Care 16(Suppl 1):P398. doi: 10.1186/cc11005
  14. 14.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  15. 15.
    Linder M, Wacha H, Wesch G, Feldmann U (1986) Pertinent clinical parameters influencing mortality in bacterial peritonitis: mannheim peritonitis index (MPI). Langenbeck’s Arch Surg 369:788Google Scholar
  16. 16.
    Wittmann DH, Teichmann W, Müller M (1987) 176. Entwicklung und Validierung des Peritonitis-Index-Altona (PIA II). Langenbeck’s Arch Surg 372:834–835Google Scholar
  17. 17.
    Elebute EA, Stoner HB (1983) The grading of sepsis. Br J Surg 70:29–31PubMedCrossRefGoogle Scholar
  18. 18.
    Tridente A, Clarke G, Walden A, McKechnie S, Hutton P, Martynoga R, Mills G, Gordon A, Stueber F, Garrard C, Hinds C (2011) Epidemiology of faecal peritonitis in the GenOSept cohort, European Society of Intensive Care Medicine (ESICM) annual conference, Berlin. Accessed 26 July 2013
  19. 19.
    Levy M, Fink M, Marshall J (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256PubMedCrossRefGoogle Scholar
  20. 20.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) 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 22:707–710PubMedCrossRefGoogle Scholar
  21. 21.
    Schoenfeld D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69:239–241CrossRefGoogle Scholar
  22. 22.
    Therneau TM, Grambsh PM (2000) Modeling survival data: extending the Cox model. Springer, New YorkCrossRefGoogle Scholar
  23. 23.
    Angus D, Kelley M, Schmitz R (2000) Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 284:2762–2770PubMedCrossRefGoogle Scholar
  24. 24.
    Rosenthal G, Kaboli P, Barnett M (2002) Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc 50:1205–1212PubMedCrossRefGoogle Scholar
  25. 25.
    Van Den Noortgate N, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256CrossRefGoogle Scholar
  26. 26.
    Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818PubMedCrossRefGoogle Scholar
  27. 27.
    Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058PubMedCrossRefGoogle Scholar
  28. 28.
    Ostermann M, Chang R (2008) Correlation between the AKI classification and outcome. Crit Care 12:R144PubMedCrossRefGoogle Scholar
  29. 29.
    Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA (2008) Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med 36:1397–1403PubMedCrossRefGoogle Scholar
  30. 30.
    Laupland KB, Zahar JR, Adrie C, Schwebel C, Goldgran-Toledano D, Azoulay E, Garrouste-Orgeas M, Cohen Y, Jamali S, Souweine B, Darmon M, Timsit JF (2012) Determinants of temperature abnormalities and influence on outcome of critical illness. Crit Care Med 40:145–151PubMedCrossRefGoogle Scholar
  31. 31.
    Tiruvoipati R, Ong K, Gangopadhyay H, Arora S, Carney I, Botha J (2010) Hypothermia predicts mortality in critically ill elderly patients with sepsis. BMC Geriatrics 10:70PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Laupland KB, Zahar JR, Adrie C, Minet C, Vesin A, Goldgran-Toledano D, Azoulay E, Garrouste-Orgeas M, Cohen Y, Schwebel C, Jamali S, Darmon M, Dumenil AS, Kallel H, Souweine B, Timsit JF (2012) Severe hypothermia increases the risk for intensive care unit-acquired infection. Clin Infect Dis 54:1064–1070PubMedCrossRefGoogle Scholar
  33. 33.
    Shander A, Knight K, Thurer R, Adamson J, Spence R (2004) Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med 116(Suppl 7A):58S–69SPubMedCrossRefGoogle Scholar
  34. 34.
    Qiu MZ, Yuan ZY, Luo HY, Ruan DY, Wang ZQ, Wang FH, Li YH, Xu RH (2010) Impact of pretreatment hematologic profile on survival of colorectal cancer. Tumour Biol 31:255–260PubMedCrossRefGoogle Scholar
  35. 35.
    Vignot S, Spano JP (2005) Anemia and colorectal cancer. Bull Cancer 92:432–438PubMedGoogle Scholar
  36. 36.
    Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, Koval KJ, Siu AL (2004) The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma 18:369–374PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Beattie WS, Karkouti K, Wijeysundera DN, Tait G (2009) Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology 110:574–581PubMedCrossRefGoogle Scholar
  38. 38.
    Oliveros H, Linares E (2012) Preoperative hemoglobin levels and outcomes in cardiovascular surgical patients: systematic review and meta-analysis. Colombian J Anesthesiol 40:7Google Scholar
  39. 39.
    Hung M, Besser M, Sharples LD, Nair SK, Klein AA (2011) The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia 66:812–818PubMedCrossRefGoogle Scholar
  40. 40.
    Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P (2008) Are blood transfusions associated with greater mortality rates? Results of the sepsis occurrence in acutely ill patients study. Anesthesiology 108:31–39PubMedCrossRefGoogle Scholar
  41. 41.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  42. 42.
    Stephan F, Montblanc J, Cheffi A, Bonnet F (1999) Thrombocytopenia in critically ill surgical patients: a case-control study evaluating attributable mortality and transfusion requirements. Crit Care 3:151–158PubMedCrossRefGoogle Scholar
  43. 43.
    Lee KH, Hui KP, Tan WC (1993) Thrombocytopenia in sepsis: a predictor of mortality in the intensive care unit. Singapore Med J 34:245–246PubMedGoogle Scholar
  44. 44.
    Williamson DR, Lesur O, Tetrault JP, Nault V, Pilon D (2013) Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes. Can J Anaesth 60:641–651PubMedCrossRefGoogle Scholar
  45. 45.
    Sharma B, Sharma M, Majumder M, Steier W, Sangal A, Kalawar M (2007) Thrombocytopenia in septic shock patients–a prospective observational study of incidence, risk factors and correlation with clinical outcome. Anaesth Intensive Care 35:874–880PubMedGoogle Scholar
  46. 46.
    Crowther MA, Cook DJ, Meade MO, Griffith LE, Guyatt GH, Arnold DM, Rabbat CG, Geerts WH, Warkentin TE (2005) Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 20:348–353PubMedCrossRefGoogle Scholar
  47. 47.
    Wong PF, Gilliam AD, Kumar S, Shenfine J, O’Dair GN, Leaper DJ (2005) Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. Cochrane Database Syst Rev CD004539. doi: 10.1002/14651858.CD004539.pub2

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Ascanio Tridente
    • 1
  • Geraldine M. Clarke
    • 2
  • A. Walden
    • 3
  • S. McKechnie
    • 4
  • P. Hutton
    • 4
  • G. H. Mills
    • 10
  • A. C. Gordon
    • 5
  • P. A. H. Holloway
    • 5
  • J.-D. Chiche
    • 6
  • J. Bion
    • 7
  • F. Stuber
    • 8
  • C. Garrard
    • 4
  • C. J. Hinds
    • 9
  • GenOSept Investigators
  1. 1.Whiston Hospital, Prescot, Merseyside and Academic Unit of Medical Education, The Medical SchoolUniversity of SheffieldSheffieldUK
  2. 2.The Wellcome Trust Centre for Human GeneticsUniversity of OxfordOxfordUK
  3. 3.Intensive Care UnitRoyal Berkshire HospitalReadingUK
  4. 4.Intensive Care UnitJohn Radcliffe HospitalOxfordUK
  5. 5.Imperial CollegeLondonUK
  6. 6.Hospital CochinParisFrance
  7. 7.School of Clinical and Experimental MedicineUniversity of BirminghamBirminghamUK
  8. 8.Department of Anaesthesiology and Pain MedicineBern University Hospital and University of BernBernSwitzerland
  9. 9.Barts and the London Queen Mary School of MedicineLondonUK
  10. 10.Intensive Care Unit, Northern General HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK

Personalised recommendations