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A Prospective Study

John M. A. Bohnen, MD, FRCS(C); Robert A. Mustard, MD, FRCS(C); Susan E. Oxholm, RN; B. Diana Schouten, RN

Arch Surg. 1988;123(2):225-229.

Abstract
• Therapeutic trials for intra-abdominal sepsis require pretreatment stratification; physiologic scoring has been recently proposed for this purpose. We have prospectively tested the validity of one such scoring system, namely, the Acute Physiology and Chronic Health Evaluation (APACHE II). As part of a larger database, we correlated APACHE II scores with mortality in 100 patients hospitalized for generalized peritonitis or abdominal abscess. Use of steroids was recorded because of our suspicion that steroids increase mortality but blunt the physiologic response to sepsis. Thirty-one patients died, including 12 of 19 patients receiving steroids. Stepwise discriminant analysis revealed that the APACHE II score and steroid use were each independently associated with the rate of mortality. We report a prospective validation of pretreatment APACHE II scoring in abdominal sepsis. Steroid use is an independent risk factor.

(Arch Surg 1988;123:225-229)

Author Affiliations
From the Department of Surgery, The Wellesley Hospital (Drs Bohnen and Mustard and Mss Oxholm and Schouten), Toronto, and the University of Toronto (Drs Bohnen and Mustard).

Footnotes
Accepted for publication July 24, 1987.

Read before the Seventh Annual Meeting of the Surgical Infection Society, Philadelphia, May 11, 1987.

Reprint requests to Department of Surgery, The Wellesley Hospital, E. K. Jones Bldg, Room 204,106 Wellesley St E, Toronto, Ontario, Canada M4Y 1J3 (Dr Bohnen).

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