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Outcome of faecal peritonitis in the ICU

Introduction

Faecal peritonitis often leads to intensive care admission. Anecdotally, patients with co-existing malignancy had an improved outcome. A retrospective analysis of all patients admitted to intensive care over 7 years was conducted to investigate this observation and identify factors that are associated with outcome from faecal peritonitis in intensive care.

Methods

A retrospective analysis of all cases of faecal peritonitis admitted to the Royal Liverpool University Hospital ICU over 7 years. Clinical records, laboratory results, histology reports and radiological data were accessed. Statistical analysis was performed using chi-squared and Student's t tests.

Results

A total of 133 patients were admitted to intensive care in 7 years. Thirty-six patients had underlying malignancy. Predicted mortality, indicated by APACHE II score, was similar in both groups (malignancy: 17.1, nonmalignancy: 16.2). Inpatient mortality was lower in patients with malignancy than those without (malignancy: 21.6%, nonmalignancy: 38.1%, P < 0.1) and shorter ITU stay (malignancy: 6.8 days, nonmalignancy: 12.7 days, P ≤0.0005). Cancer patients required a shorter period of TPN or NG feeding (malignancy: 4.29 days, nonmalignancy: 7.7 days, P < 0.05), and a shorter duration of inotropic support (malignancy: 2.54 days, nonmalignancy: 4.44 days, P < 0.05). Peak inflammatory markers are lower in patients with malignancy, notably neutrophil count (malignancy: 21.15, nonmalignancy: 24.9, P < 0.05).

The mean APACHE II score was significantly lower in cases who survived, compared to those who did not (nondeaths: 15.3, deaths: 19.3, P < 0.005). Mean albumin at admission was similar for patients who survived compared to those who did not (deaths: 18.2, nondeaths: 18.6); however, minimum albumin during admission is significantly lower in patients who died than those who survived (deaths: 10.33, nondeaths: 13.24, P < 0.005). Duration of feeding support (TPN or NG feeding) and time to commencement of feeding showed no difference between patients who survived and those who did not.

Conclusion

Underlying malignancy is associated with an increased survival, shorter ITU stay, less requirement for inotropic support and decreased inflammatory markers potentially due to a less aggressive inflammatory response as a consequence of the presence of malignancy. In this series, delay to introduction of nutrition and length of nutritional support are not associated with outcome; however, low albumin is associated with a poor outcome, although it is not clear if this is secondary to nutrition or inflammation.

Author information

Correspondence to J Sayer.

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Sayer, J., Simpson, G., Mccrossan, L. et al. Outcome of faecal peritonitis in the ICU. Crit Care 16, P398 (2012). https://doi.org/10.1186/cc11005

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Keywords

  • Retrospective Analysis
  • Inflammatory Marker
  • Neutrophil Count
  • Nutritional Support
  • Inotropic Support