Abstract
Objective: To develop and validate a scoring system to predict the risk of in-hospital death in patients with intra-abdominal infection (IAI).Materials and Methods: Patients with IAI (n = 417) treated at our hospital between June 2010 and May 2020 were retrospectively reviewed. Risk factors for in-hospital death were identified by logistic regression analysis. The regression coefficients of each risk factor were re-assigned using the mathematical transformation principle to establish a convenient predictive scoring system. The scoring system was internally validated by bootstrapping sample method.Results: Fifty-three (53/417, 12.7%) patients died during hospitalization. On logistic regression analysis, high APACHE II score (P = 0.012), pneumonia (P = 0.002), abdominal surgery (P = 0.001), hypoproteinemia (P = 0.025), and chronic renal insufficiency (P = 0.001) were independent risk factors for in-hospital death. On receiver operating characteristic curve analysis, the composite index combining these five risk factors showed a 62.3% sensitivity and 80.2% specificity for predicting in-hospital death (area under the curve: 0.778; 95% confidence interval: 0.711–0.845, P < 0.001). The predictive ability of the composite index was better than that of each independent risk factor. A scoring system (0–14 points) was established by re-assigning each risk factor based on the logistic regression coefficient: APACHE II score (10–15 score, 1 point; >15 score, 4 points); pneumonia (2 points), abdominal surgery (2 points), hypoproteinemia (2 points), and chronic renal insufficiency (4 points). Internal validation by 1,000 bootstrapping sample showed relatively high discriminative ability of the scoring system (C-index = 0.756, 95% confidence interval: 0.753–0.758).Conclusions: The predictive scoring system based on APACHE II score, pneumonia, abdominal surgery, hypoproteinemia, and chronic renal insufficiency can help predict the risk of in-hospital death in patients with IAI.
Highlights
Intra-abdominal infection (IAI) is a common cause of admission to the intensive care unit, and is the second most common cause of septic shock after respiratory tract infection [1, 2]
The C-index and 95% confidence interval (CI) across the bootstrapping sample datasets were used to evaluate the stability of the established predictive scoring model
High APACHE Acute Physiology and Chronic Health Evaluation II (II) score (P = 0.012), pneumonia (P = 0.002), abdominal surgery (P = 0.001), hypoproteinemia (P = 0.025), and chronic renal insufficiency (P = 0.001) were identified as independent risk factors for inhospital death [area under the curve (AUC): 0.607, 0.606, 0.611, 0.562, and 0.570, respectively]
Summary
Intra-abdominal infection (IAI) is a common cause of admission to the intensive care unit, and is the second most common cause of septic shock after respiratory tract infection [1, 2]. The poor prognosis of patients with IAI, especially death, is the core concern of family members and clinicians. The personal experience of clinicians alone is not sufficient to provide an accurate clinical prognosis for patients and their families. Pessimistic expectation of the patients’ prognosis often leads to premature withdrawal of treatment by the family members. Development of objective measures for prognostic assessment of patients with IAI in clinical practice may help inform better treatment decision-making that is most conducive to the situation of individual patients and their care givers. Independent risk factors were identified and a scoring system to predict the risk of in-hospital death was developed. A simple scoring system for predicting the risk of in-hospital death of IAI patients was established by converting the risk factors through use of mathematical principles
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