Predictive Role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in Patients With Peritonitis at the National Hospital Abuja.

Abstract

A validated tool may facilitate assessing the severity of peritonitis among surgical patients. This study evaluates the predictive role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in the surgical outcomes of patients managed for peritonitis in Abuja. This is a prospective study of consecutive adult patients managed for peritonitis by the general surgery unit of National Hospital Abuja (NHA) over a 19-month period (September 2020 through March 2022). Patient characteristics and treatment outcomes were recorded in a structured proforma and analyzed using SPSS Statistics version 25 (IBM Corp., Released 2017; IBM SPSS Statistics for Windows, Version 25.0; Armonk, NY: IBM Corp.). The accuracy, sensitivity, specificity, and threshold of APACHE II were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. There were 54 patients with peritonitis during the study period, with a male-to-female ratio of 2.6:1. This study's mortality and morbidity rates were 13.0% and 63.0%, respectively. The APACHE II score at admission was positively correlated with the likelihood of postoperative mortality, morbidity, number of postoperative complications, ICU admission, and length of hospital admission. The average APACHE II score of patients in this study was 7.1±5.2. APACHE II best-predicted mortality by the ROC curve at a threshold point of 9 (sensitivity of 85.7%, specificity of 70.2%, the accuracy of 86.8%, P-value 0.002). At a threshold score of 6, APACHE II was significantly associated with the occurrence of postoperative morbidity (sensitivity of 74.3%, specificity of 73.7%, accuracy of 75.2%, P-value = 0.043). This study confirms that the APACHE II score at admission can predict the outcome of surgery within the first 30 days post-surgery among adult patients who had peritonitis at NHA.