Comparision of the PIPAS severity score and the qSOFA criteria for predicting in-hospital mortality of peritonitis at Mulago Hospital: a prospective cohort study.

Abstract

Background: Mortality associated with delayed management of peritonitis is up to 40%. Early prognostic assessment is critical to select high-risk patients for a prompt, more aggressive therapeutic approach but most risk prognostic tools for peritonitis do not guarantee this. The qSOFA criteria and PIPAS severity score are simple, strictly preoperative, and bedside tools but the validity of the latter tool for predicting peritonitis mortality in a low-resourced surgical emergency center is yet to be evaluated.

Objective: To assess the validity of the PIPAS severity score in comparison with the qSOFA criteria for predicting in-hospital mortality among patients with peritonitis in a low-resourced surgical emergency center.

Method: We conducted a prospective cohort study on peritonitis patients managed surgically at Mulago National Referral Hospital between October 2020 to June 2021. PIPAS severity score and qSOFA were assessed preoperatively and then each patient was followed up intra- and postoperatively until death, discharge from the hospital, or up to 30 days post-admission in cases of prolonged hospital stay. We used ROC curve analysis to assess and compare the validity of the PIPAS severity score and the qSOFA criteria for predicting peritonitis mortality. Statistical analyses were done using STATA version 16. All tests were 2 sided (p < 0.05).

Results: We evaluated 136 peritonitis patients. Their mean age was 34.4 +14.5, male to female ratio was 3:1. The overall mortality rate was 12.5%. We found the best cut-off scores for predicting peritonitis in-hospital mortality for both PIPAS and the qSOFA tools to be a score of > 2. The sensitivity, specificity, and AUROC for the PIPAS tool were 76.5%, 93.3%, and 0.893 respectively while the respective values for the qSOFA tool were 58.8%, 98.3%, and 0.770.

Conclusion: The PIPAS severity score tool has a better predictive ability for peritonitis mortality and is more sensitive than the qSOFA criteria although the latter tool is more specific.