[Generalized secondary peritonitis: predictors of in-hospital mortality and survival and mortality evolutive links]. / Peritonitis secundaria generalizada: predictores de mortalidad y sobrevida, y vinculantes evolutivos de mortalidad.

BACKGROUND: The knowledge of mortality predictors and evolutive variables linked with in-hospital death can help us to optimize corrective procedures. OBJECTIVES: To identify independent predictors of in-hospital mortality and survival, and independent evolutive links with death in patients with generalized secondary peritonitis (GSP). METHODS: Two hundred and forty-two patients admitted into the hospital due to GSP were followed until in-hospital death or hospital discharge. Mortality and survival predictors were identified from several variables evaluated at the time of admission and evolutive links to death from evolutive variables. RESULTS: In-hospital mortality was 16.5%. Independent mortality predictors were APACHE II > or =16 [OR=31,9 (IC 95% 10.5-96,5)] and chronic renal failure history, with specificity (1) An appropriate nutritional condition was the only survival predictor [OR = 0.2 (IC 95% 0.1-0.6)]. The highest contribution to APACHE II predictive power came from the deterioration of blood tests values and vital signs, followed by age, sensory condition, and medical history. Independent evolutive links to mortality were multiorganic dysfunction involving three or more organs [OR = 63.2 (IC 95% 18.4-217)], hemodynamic failure and septic shock, and necessity of vital support with mechanical ventilation and/or inotropic/vasoconstrictor drugs. CONCLUSIONS: In generalized secondary peritonitis the independent predictors of in-hospital mortality are APACHE II score > or =16 and chronic renal failure history, not very useful due to the low prevalence. The only independent survival predictor is an appropriate nutritional status. The evolutive links to mortality are multiorganic dysfunction involving three or more organs, hemodynamic failure and septic shock, and necessity of vital-support with mechanical ventilation and/or inotropic/vasoconstrictor agents.

[Predictors of intrahospitalary mortality in the upper gastrointestinal variceal bleeding due to chronic liver disease treated endoscopically]. / Predictores de mortalidad hospitalaria en la hemorragia digestiva alta variceal por hepatopatía crónica tratada endoscópicamente.

UNLABELLED: Upper gastrointestinal variceal bleeding is one of the most serious complications in patients with chronic liver disease. The aim of this trial is to identify in hospital mortality predictors in this illness. MATERIAL AND METHODS: 106 hospitalizations due to this disease from October 2001 to April 2006 in cohort design. In hospital mortality was confronted with age, sex, liver disease etiology, Apache II score at admission, variceal severity, severity of the hepatic failure evaluated according to the Child Pugh's classes, a history of variceal bleeding, initial endoscopic treatment failure, haemostatic failure within the first 48 hours, and rebleeding after 48 hours from admission. In order to identify independent mortality predictors, all the variables correlated significantly with hospital mortality were selected. For the quantitative variable APACHE II score at admission, the best mortality discrimination value was chosen. RESULTS: independent in hospital mortality predictors were: initial endoscopic treatment failure (p = 0.005), haemostatic failure in the first 48 hours (p = 0.012), and Child Pugh C class (p = 0.024). Although male sex, Apache II score at admission and rebleeding after 48 hours were also significantly related to mortality by univaried model, they did not qualify as independent predictors. CONCLUSIONS: the independent predictors of intrahospitalary mortality in patients with variceal bleeding due to chronic liver disease, and first-line of endoscopic treatment were: 1) Initial haemostatic endoscopic treatment failure, 2) Haemostatic failure in the first 48 hs, and 3) Child Pugh C class hepatic failure at admission.

Predictores de mortalidad hospitalaria en la hemorragia digestiva alta variceal por hepatopatía crónica tratada endoscópicamente / Predictors of intrahospitalary mortality in the upper gastrointestinal variceal bleeding due to chronic liver disease treated endoscopically

La hemorragia digestiva alta variceal es una de las complicaciones más graves en la hepatopatía crónica. El objetivo de este trabajo es identificar variables que predicen mortalidad hospitalaria. Material y métodos: 106 internaciones por esta patología desde octubre de 2001 hasta abril de 2006 en diseño de cohortes. Se confrontó mortalidad hospitalaria con edad, sexo, etiología de la hepatopatía, score APACHE II al ingreso, imensión de las várices evaluada endoscópicamente, severidad de la insuficiencia hepática evaluada por clases de Child Pugh, antecedente de hemorragia variceal, fracaso de la terapia endoscópica inicial, fracaso hemostático en las primeras 48hs y resangrado posterior a 48hs. Para identificar predictores independientes de mortalidad se seleccionaron todas las variables que correlacionaron significativamente con muerte hospitalaria. Para la variable cuantitativa score APACHE II de ingreso se consideró el valor que mejor discriminó mortalidad. Resultados: los predictores independientes de muerte hospitalaria fueron: el fracaso de la terapia endoscópica inicial (p=0,005), el fracaso hemostático en las primeras 48hs (p=0,012) y la clase C de Child Pugh (p=0,024). Si bien en el sexo masculino el score APACHE II al ingreso y el resangrado con posterioridad a las 48hs también correlacionaron con mortalimortalidad, no calificaron como predictores independientes. Conclusión: en portadores de hepatopatía crónica con hemorragia digestiva alta variceal y primera línea de tratamiento endoscópico, resultaron predictores independientes de muerte hospitalaria: 1) el fracaso de la terapia endoscópica hemostática inicial, 2) el fracaso hemostático en las primeras 48hs, y 3) la clase C de Child Pugh al ingreso.

Upper gastrointestinal variceal bleeding is one of the most serious complications in patients with chronic liver disease. The aim of this trial is to identify in hospital mortality predictors in this illness. Material and methods: 106 hospitalizations due to this disease from October 2001 to April 2006 in cohort design. In hospital mortality was confronted with age, sex, liver disease etiology, Apache II score at admission, variceal severity, severity of the hepatic failure evaluated according to the Child Pugh’s classes, a history of variceal bleeding, initial endoscopic treatment failure, haemostatic failure within the first 48 hours, and rebleeding after 48 hours from admission. In order to identify independent mortality predictors, all the variables correlated significantly with hospital mortality were selected. For the quantitative variable APACHE II score at admission, the best mortality discrimination value was chosen. Results: independent in hospital mortality predictors were: initial endoscopic treatment failure (p = 0,005), haemostatic failure in the first 48 hours (p = 0,012), and Child Pugh C class (p = 0,024). Although male sex, Apache II score at admission and rebleeding after 48 hours were also significantly related to mortality by univaried model, they did not qualify as independent predictors. Conclusions: the independent predictors of intrahospitalary mortality in patients with variceal bleeding due to chronic liver disease, and firstline of endoscopic treatment were: 1) Initial haemostatic endoscopic treatment failure, 2) Haemostatic failure in the first 48hs, and 3) Child Pugh C class hepatic failure at admission.