Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis

Abstract.

Objective: To evaluate the time-course of two organ failure scores (SOFA and Goris) after surgery for postoperative peritonitis in critically ill patients according to the persistence/nonpersistence of intraabdominal sepsis (IAS). Design: Retrospective study. Patients: Sixty-two consecutive patients (SAPSII = 38±14) admitted in the surgical ICU. Methods: Patients were classified according to the persistence of IAS (IAS+, n=36) confirmed by a second laparotomy or the lack of IAS (IAS-, n=26) assessed by a favorable 30-day evolution without reintervention. Scores were calculated daily from day 0 preoperatively to postoperative day 5. Results: In both groups, SOFA scores were higher on day 1 when compared to day 0 (8.3±3.1 vs 6.1±3.7 in the IAS+ group and 5.2±3.4 vs 2.7±2.7 in the IAS- group). In the IAS- patients, the SOFA score displayed a decrease starting on day 2 when compared to day 1 (4.4±3.6 vs 5.2±3.4, P=0.03). In contrast, in the IAS+ patients, the SOFA score remained unchanged until day 5. The time course of the Goris score was strictly similar to the SOFA scores. Conclusion: In critically ill patients with postoperative peritonitis, the postoperative time course of the SOFA and the Goris organ failure scores was different between patients with or without intra-abdominal persistent sepsis. The lack of improvement of one of these scores on postoperative day 2 may suggest persistent intraabdominal sepsis and supports the need for a new surgical exploration.