Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in‑hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
BMC surgery
Abstract
The majority of the prognostic scoring tools for peritonitis are impractical in low resource settings
because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA)
score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside
prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive
ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis.
Method: This was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital
in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively
for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital,
or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used
Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for
peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals.
Results: We evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male
to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a
significantly better discriminative ability (AUC = 0.893, 95% CI 0.801–0.986) than the qSOFA score (AUC = 0.770, 95% CI
0.620–0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity
and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2),
were 58.8% and 98.3% respectively.
Conclusions: The in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool
has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool
although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic
tool for peritonitis cases in the emergency department.
Description
Keywords
PIPAS, qSOFA, Peritonitis, Mortality
Citation
Iranya, R. N., Mbiine, R., Semulimi, A. W., Nasige, J., Makumbi, T., & Galukande, M. (2022). Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in-hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study. BMC surgery, 22(1), 291. https://doi.org/10.1186/s12893-022-01743-4