Metamizole outperforms meloxicam in sepsis: insights on analgesics, survival and immunomodulation in the peritoneal contamination and infection sepsis model.

Background: Limited availability and side effects of opioids have led to an increased use of non-opioid analgesia in animal disease models. However, by affecting the immune-inflammatory reactions, analgesia may disrupt the resolution of the host inflammation and modulate the survival in septic animals. This study used a clinically relevant sepsis mouse model of peritoneal contamination and infection (PCI) to investigate the antinociceptive and anti-inflammatory properties of two non-opioid analgesics. Methods: Adult C57BL/6J mice were intraperitoneally injected with a human feces suspension and received either no analgesics (Non-A), Meloxicam, or Metamizole orally. The mice were monitored for pain and illness. Mortality was assessed at 7 days post-PCI. A separate group of mice was sacrificed 24 hours after infection. Blood, peritoneal lavage fluid (PLF), liver, and spleen were harvested for pathogen load quantification via qPCR, macrophage phenotyping, neutrophil infiltration/activation, and systemic/tissue cytokine release by flow cytometry. Results: Meloxicam but not Metamizole reduced the mortality of septic mice by 31% on day 7 compared to the Non-A group. Both analgesics effectively alleviated pain but did not affect illness severity, body weight, and temperature. Meloxicam quadrupled the bacterial burden in the blood and PLF. In high IL-6 responders, Meloxicam treatment was associated with reduced circulating IL-10 and IL-1ß compared to the Non-A septic group. In low IL-6 responders, Meloxicam increased circulating MCP-1 levels and decreased PGE2 levels compared to Non-A septic mice. Notably, Meloxicam reduced spleen neutrophil infiltration by 20% compared to two other sepsis groups. Conclusion: Metamizole and Meloxicam effectively relieved pain and increased the animals' basal activity in the PCI sepsis model. Meloxicam prolonged survival yet triggered maladaptive responses due to its immunosuppressive features that decreased tissue bacterial clearance during sepsis. In contrast, Metamizole constitutes a safe and effective non-opioid alternative for analgesic control in the non-surgical PCI sepsis model.

Factors Affecting Postoperative Early-term Mortality and Anastomotic Leakage in Geriatric Colorectal Cancer Patients.

AIM: In terms of early-term mortality, there may be variability in terms of factors belonging to age groups. While some risk factors apply to all patients undergoing colorectal cancer surgery, some factors may come to the fore in terms of age. There have been very few studies on factors that increase the risk of early-term mortality, especially for geriatric patients. It was aimed to compare factors influencing prognosis and mortality within the first 30 postoperative days between geriatric patients and those <65 years of age, and to identify factors that increase the risk of anastomotic leakage and early-term mortality, particularly in geriatric patients. METHODS: Clinical, laboratory, and pathology findings from 341 patients (186 geriatric) who underwent surgery for colorectal cancer between January 2016 and December 2019 were collected and analyzed. In terms of categorical variables, comparisons between groups were made with Pearson's Chi Square test and Fisher's Exact Test. Risk coefficients of variables in terms of anastomotic leakage and early-term mortality were determined by logistic regression analysis. The results were evaluated within the 95% Confidence interval, and p < 0.05 values were considered significant. RESULTS: Anastomotic leakage was detected in 7% of patients, and 6.2% of the patients died within the first 30 postoperative days. The 30-day postoperative mortality rate was significantly higher in geriatric patients with hypertension (p = 0.003), those undergoing emergency surgery (p = 0.007), those with stage 4 tumors (p < 0.001), those with ostomy-related complications (p = 0.042), those who developed intraabdominal abscess or peritonitis (p < 0.001), those with respiratory failure (p = 0.009), and those with perforation (p = 0.001). In patients <65 years of age, groups stratified by these variables did not differ significantly in terms of early-term mortality rate (p > 0.05 for each). CONCLUSIONS: These findings show that lack of bowel preparation and development of intraabdominal abscess/peritonitis significantly increase early-term mortality rates in both <65 and geriatric patients. Additionally, hypertension, emergency surgery, advanced tumor stage, development of ostomy-related complications, respiratory failure, and perforation significantly increase early-term mortality solely in geriatric patients.

[When should a liver disease patient be admitted to the intensive care unit?] / Wann soll ein Leberkranker auf die Intensivstation?

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.

Impacts of rifaximin and midodrine on morbidity, mortality, and quality of life in patients with decompensated liver cirrhosis.

BACKGROUND: Vasodilatation and bacterial dislocation are the main contributors to the catastrophic events in patients with decompensated liver cirrhosis (DLC). AIM: The aim of this study was to evaluate the impacts of adding midodrine and rifaximin on morbidity, mortality, and quality of life in patients with DLC. METHODS: This interventional clinical study included 100 consecutively enrolled DLC patients randomized 1 : 1 into two groups. Group A received oral midodrine (5 mg/8 h) and rifaximin (550 mg/12 h) with standard diuretic therapy, while group B received only standard diuretic therapy. Clinical and laboratory data, including the McGill Quality of Life Questionnaire, were evaluated over a 3-month treatment period. RESULTS: In the study group, there was a significant reduction in Child-Pugh and Model for End-Stage Liver Disease scores, international normalized ratio, and mean arterial blood pressure at 2, 6, and 12 weeks (P < 0.05). Ascites, spontaneous bacterial peritonitis incidence, hematemesis, paracentesis need, and hepatic encephalopathy showed improvement after 12 weeks compared with the control group. McGill Quality of Life Questionnaire significantly improved after 6 and 12 weeks (P < 0.05). Survival rates demonstrated a noteworthy improvement (P = 0.014), substantiated by evidence in both univariate and multivariate regression analyses. CONCLUSION: Combined midodrine with rifaximin represents an endowment to patients with DLC with spectacular improvements in synthetic liver functions, along with improved quality of life, and survival.

LINAS-Score: prognostic model for mortality assessment in patients with cirrhotic liver and infected ascites.

BACKGROUND AND AIM: Patients with liver cirrhosis often face a grave threat from infected ascites (IA). However, a well-established prognostic model for this complication has not been established in routine clinical practice. Therefore, we aimed to assess mortality risk in patients with liver cirrhosis and IA. METHODS: We conducted a retrospective study across three tertiary hospitals, enrolling 534 adult patients with cirrhotic liver and IA, comprising 465 with spontaneous bacterial peritonitis (SBP), 34 with bacterascites (BA), and 35 with secondary peritonitis (SP). To determine the attributable mortality risk linked to IA, these patients were matched with 122 patients with hydropic decompensated liver cirrhosis but without IA. Clinical, laboratory, and microbiological parameters were assessed for their relation to mortality using univariable analyses and a multivariable random forest model (RFM). Least absolute shrinkage and selection operator (Lasso) regression model was used to establish an easy-to-use mortality prediction score. RESULTS: The in-hospital mortality risk was highest for SP (39.0%), followed by SBP (26.0%) and BA (25.0%). Besides illness severity markers, microbiological parameters, such as Candida spp., were identified as the most significant indicators for mortality. The Lasso model determined 15 parameters with corresponding scores, yielding good discriminatory power (area under the receiver operating characteristics curve = 0.89). Counting from 0 to 83, scores of 20, 40, 60, and 80 corresponded to in-hospital mortalities of 3.3%, 30.8%, 85.2%, and 98.7%, respectively. CONCLUSION: We developed a promising mortality prediction score for IA, highlighting the importance of microbiological parameters in conjunction with illness severity for assessing patient outcomes.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis.

INTRODUCTION: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. METHODS: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. RESULTS: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. CONCLUSION: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

Listeria monocytogenes-associated spontaneous bacterial peritonitis in France: a nationwide observational study of 208 cases.

BACKGROUND: Listeriosis is a foodborne infection caused by Listeria monocytogenes. Three main forms of listeriosis are well characterised, but little is known about L monocytogenes-associated spontaneous bacterial peritonitis. We used data from the French national surveillance of listeriosis to perform a nationwide retrospective study. METHODS: All patients with L monocytogenes isolated by culture from a peritoneal fluid sample in France between April 1, 1993, and Dec 31, 2022, were included. Individuals for whom bacterial peritonitis was not confirmed and those who also had another type of invasive listeriosis were excluded. A standardised checklist was used to collect demographic, clinical, and biological data as well as antibiotic treatment and follow-up data. The primary outcome was to determine the characteristics of L monocytogenes-associated spontaneous bacterial peritonitis. We did descriptive analyses and assessed risk factors for 1-month mortality using an exploratory multivariable Cox model analysis. FINDINGS: Among the 8768 L monocytogenes cases reported, 208 (2%) were patients with L monocytogenes-associated spontaneous bacterial peritonitis. Mean age was 65 years (SD 13), 50 (24%) of 208 patients were female, and 158 (76%) were male (no data on race or ethnicity were available). 200 (98%) of 205 patients with L monocytogenes-associated spontaneous bacterial peritonitis with available data had immunosuppressive comorbidities, including cirrhosis (148 [74%] of 201 with available data), ongoing alcoholism (58 [62%] of 94), and ongoing neoplasia (60 [31%] of 195). Causes of ascites included cirrhosis (146 [70%] of 208), ongoing neoplasia (26 [13%]), end-stage heart failure (13 [6%]), and peritoneal dialysis (11 [5%]). Among those with available data, presentation was pauci-symptomatic and non-specific; only 67 (50%) of 135 patients presented with fever, 49 (37%) of 132 with abdominal pain, and 27 (21%) of 129 with diarrhoea. 61 (29%) of 208 patients were dead at 1 month, 92 (44%) were dead at 3 months, and 109 (52%) were dead at 6 months after diagnosis. Ongoing neoplasia (hazard ratio 2·42 [95% CI 1·05-5·56]; p=0·039), septic shock (8·03 [2·66-24·02]; p=0·0021), and high blood leukocyte count (1·05 [1·00-1·09]; p=0·045) were independently associated with 1-month mortality. INTERPRETATION: Despite the non-specific and mild presentation of L monocytogenes-associated spontaneous bacterial peritonitis, the outcome is poor and similar to that of neurolisteriosis, and so identification of L monocytogenes in ascitic fluid samples requires urgent parenteral amoxicillin-based treatment to avoid a fatal outcome. FUNDING: Institut Pasteur, Inserm, and French Public Health Agency. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients.

BACKGROUND: The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI. METHODS: The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared. RESULTS: Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan-Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722-1.981] (p = 0.488)). CONCLUSION: In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.

Diagnostic Paracentesis Within 1 Day Is Associated With Reduced Mortality and Length of Hospital Stay in Patients with Cirrhosis and Ascites.

Spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis and is associated with high mortality. Although recent literature reports mortality benefits to early diagnostic paracentesis, current guidelines do not offer specific recommendations for how quickly diagnostic paracentesis should be performed in patients with cirrhosis and ascites who are admitted to the hospital. Therefore, we conducted a systematic review and meta-analysis to evaluate outcomes among patients admitted to the hospital with cirrhosis and ascites receiving paracentesis within ≤ 12, ≤ 1 day, and > 1 day. Eight studies with 116,174 patients were included in the final meta-analysis. The pooled risk of in-hospital mortality was significantly lower in patients who underwent early (≤ 12 h or ≤ 1 day) compared to delayed (> 12 h or > 1 day) paracentesis (RR: 0.69, p < 0.00001), and in patients who underwent paracentesis compared to no paracentesis (RR: 0.74, p < 0.00001). On subgroup analysis, in-hospital mortality was significantly lower in both paracentesis within ≤ 12 h (RR: 0.61, p = 0.02) vs. > 12 h, and within ≤ 1 day (RR: 0.70, p < 0.00001) vs. > 1 day. While there was a trend towards decreased mortality in those undergoing paracentesis within ≤ 12 h compared to ≤ 1 day, the difference did not reach statistical significance. The length of hospital stay was significantly shorter by 5.38 days in patients who underwent early (≤ 12 h) compared to delayed (> 12 h) paracentesis (95% CI 4.24-6.52, p < 0.00001). Early paracentesis is associated with reduced mortality and length of hospital stay. We encourage providers to perform diagnostic paracentesis in a timely manner, at least within 1 day of hospital admission, for all patients with cirrhosis and ascites.

The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis.

To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.

Morbimortalidad en pacientes con peritonitis apendicular sometidos a cirugía laparoscópica / Morbimortality in patients with appendicular peritonitis undergoing laparoscopic surgery

Objetivo: Describir la morbimortalidad de los pacientes con diagnóstico de peritonitis apendicular, sometidos a cirugía laparoscópica en el Servicio de Cirugía General del Hospital Universitario de Caracas, durante el periodo enero 2013 - diciembre 2018. Métodos: estudio retrospectivo, descriptivo, observacional de corte transversal. Se revisaron las historias clínicas de los pacientes con peritonitis apendicular que fueron sometidos a cirugía laparoscópica en los servicios de Cirugía I, II, III y IV del Hospital Universitario de Caracas, en el período enero 2013-diciembre 2018. Las variables cuantitativas se expresaron en media ± desviación estándar y variables cualitativas en frecuencia y porcentaje; los datos se procesaron en el programa estadístico SPSS 19 (SPSS, inc., Chicago, EEUU). Resultados: la muestra estuvo conformado por 60 pacientes con edades entre 12 y 78 años, con el 78,33% en el grupo etario de 10 a 29 años; el sexo masculino representó el 58,33% de la muestra, con un promedio de edad de 23,90± 11,84 años; las complicaciones se presentaron en el 18,33% de los casos, más frecuente la infección del sitio operatorio con 6,67% (n=4) de los pacientes. La estancia hospitalaria global fue de 4,80 ± 2,58 días. Un paciente falleció. Conclusiones: el abordaje laparoscópico para el tratamiento de la peritonitis apendicular difusa se relaciona con muy baja morbimortalidad postoperatoria. La complicación más frecuente fue la infección del sitio operatorio. La mayoría de los pacientes solo ameritó una intervención quirúrgica(AU)

Objective: To describe the morbimortality ofpatients with a diagnosis of appendicular peritonitis undegoinglaparoscopic surgery in the General Surgery Department of the University Hospital of Caracas, during the period January2013 - December 2018. Methods: A retrospective, descriptive,observational, cross-sectional, descriptive study was performed.the medical records of patients with appendicular peritonitis who underwent laparoscopic surgery in the Surgery I, II, III and IV services of the University Hospital of Caracas were reviewed. Period January 2013-December 2018. Quantitative variables are expressed as mean ± standard deviation and qualitative variablesas frequency and percentage. The data were processed in the SPSS 19 statistical program (SPSS, inc., Chicago, USA). Results: the sample consisted of 60 patients aged between 12 and 78 years, with 78.33% in the age group 10 to 29 years. Male sex represented 58.33% of the sample, with an average age of 23.90 ±11.84 years. Complications occurred in 18.33% of the cases, with6.67% (n=4) of the patients reporting surgical site infection. The overall hospital stays of 4.80 ± 2.58 days. One patientdied. Conclusions: the laparoscopic approach is of choice for the treatment of diffuse appendicular peritonitis. The most frequent complication was surgical site infection. Most of the patients only required one surgical intervention(AU)

Retroperitonitis apendicular: factores asociados y manejo de una complicación seria / Appendicular retroperitonitis: associated factors and management of a serious complication

Antecedentes: La retroperitonitis es una rara y severa complicación de la apendicitis. Hasta el presente solo unos pocos reportes de casos han sido publicados en la literatura inglesa. Objetivo: El objetivo de este trabajo es analizar una serie consecutiva de 11 casos tratados en nuestra institución. Materiales y Método: Análisis retrospectivo de una base de datos recolectada en forma prospectiva de todos los pacientes admitidos por retroperitonitis de origen apendicular durante el período marzo 2017-septiembre 2020. Se analizarán las variables asociadas con esta complicación y su manejo. Resultados: 11 pacientes de un total de 601 con diagnóstico de apendicitis presentaron una retroperitonitis durante el período analizado (1,83%). El retardo en el diagnóstico fue en promedio de 8 días (rango 3 - 14 días). Todos los pacientes tuvieron un apéndice retrocecal y 81% presentaron un coprolito asociado. 45% fueron manejados inicialmente con abdomen abierto y contenido, y 55% con cierre fascial primario (50% de fracaso). La morbilidad y mortalidad fueron del 81% y 18%, respectivamente Discusión: La localización retrocecal del apéndice, la presencia de un coprolito y la presentación atípica, con demora en el diagnóstico, fueron factores comunes presentes en nuestra experiencia. El manejo con cierre fascial primario fracasó en la mitad de los casos. La morbimortalidad fue elevada. Conclusión: La retroperitonitis es una infrecuente pero severa complicación de la apendicitis, con elevada morbimortalidad.

Background: Retroperitonitis is a rare and life-threatening complication of appendicitis. So far, only a few cases have been described so far in the English literature. Aim: The objetive of this paper is to analyze a consecutive series of 11 patients treated at our institution. Materials and Method: Retrospective analysis of a prospectively collected database of all patients admitted for appendicular retroperitonitis during the period March 2017-September 2020. The variables associated with this complication and its management are analyzed. Results: 11 patients from 601 with a diagnosis of appendicitis presented with retroperitonitis during the study period (1.83%). Mean delay in diagnosis was 8 days (range 3-14 days). The location of the appendix was retrocecal in all cases and 81% had an appendicolith associated. 45% were initially managed with open abdomen. A 50% failure rate occurred after primary fascial closure. Morbidity and mortality rates were 81% and 18%, respectively. Discussion: Retrocecal location of the appendix, the presence of an appendicolith and atypical presentation with delayed diagnosis were common factors present in our experience. Primary fascial closure was associated with a 50% failure rate. Morbidity and mortality were high. Conclusion: Retroperitonitis is a rare but severe complication of appendicitis, with high morbidity and mortality rates.

Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systemic review and meta-analysis.

OBJECTIVES: Several studies have compared outcomes of peritoneal dialysis (PD) between elderly and non-elderly patients but with variable results. We hereby designed this review to compare mortality, peritonitis, and technique survival between elderly and non-elderly patients on PD. METHODS: PubMed, Embase, and Google Scholar were searched for studies comparing outcomes of PD between elderly and non-elderly patients. The last search date was 14th July 2021. RESULTS: Fourteen studies were included. 12 studies defined the elderly as ≥65 years of age and these were included in the meta-analysis. Pooled analysis of crude (RR: 2.45 95% CI: 1.36, 4.40 I2 = 97% p = 0.003) and adjusted data (HR: 2.80 95% CI: 2.45, 3.09 I2 = 0% p<0.00001) indicated a statistically significant increased risk of mortality amongst elderly patients as compared to non-elderly patients. Meta-analysis of four studies demonstrated a statistically significant increased risk of peritonitis in the elderly (RR: 1.56 95% CI: 1.18, 2.07 I2 = 76% p = 0.002). Pooled analysis demonstrated no statistically significant difference in technique survival between the two groups (RR: 0.95 95% CI: 0.86, 1.05 I2 = 86% p = 0.32). CONCLUSION: Elderly patients on PD have a significantly increased risk of mortality as compared to non-elderly patients. The risk of peritonitis is also significantly increased in older adults but the increased age has no impact on technique survival. Further studies are needed to strengthen our conclusions.

Caracterización epidemiológica: análisis de tasa de mortalidad e índice de swaroop para peritonitis en el periodo 2017- 2021, en Chile / Epidemiological characterization: peritonitis mortality rate and swaroop Index in the period 2017 - 2021, in Chile

Introducción: La peritonitis alcanza una mortalidad global de hasta un 60%. Dada la falta de estudios epidemiológicos nacionales, se plantea calcular la tasa de mortalidad (TM) por peritonitis entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, ecológico, sobre defunciones por peritonitis entre los años 2017-2021 en Chile (N=1.741), en población mayor de 15 años según grupo etario, sexo y región con datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva, cálculo de TM e índice de Swaroop (IS). No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 2,47/100.000 habitantes entre los años 2017 y 2021, siendo el año 2020 la mayor con 3,07. El sexo femenino presentó una tasa de 2,65. El grupo etario con mayor TM es el de 80 y más con 141,7/100.000 habitantes. Para el IS por región, lideran las regiones XV y XII con 100%, siendo la más baja la XI con 83,3%. Discusión: El pico de TM para el año 2020 coincide con la pandemia por Covid-19, donde se reporta mayor mortalidad postoperatoria en pacientes infectados. El IS se mantiene mayor al 90% en el país, excepto en las Regiones X y XI, probablemente debido a la menor disponibilidad de centros de alta complejidad. Conclusión: Dada la ausencia de datos recientes de mortalidad para peritonitis, se realizó una actualización epidemiológica local, con perspectiva comparativa regional respecto a las TM de la población general y en mayores de 50 años.

Introduction: Peritonitis reaches an overall mortality of up to 60%. Given the lack of national epidemiological studies, it is proposed to calculate the mortality rate (MR) due to peritonitis between the years 2017-2021 in Chile. Methodology: Descriptive, ecological study about deaths by peritonitis between 2017 and 2021 in Chile (N=1,741), in a population older than 15 years old according to age group, sex, and region with data obtained from Departamento de Estadística e Información en Salud. Descriptive statistics were used, MR calculation, and Swaroop Index (SI). It did not require approval by an ethics committee. Results: A MR of 2.47/100,000 was calculated between the years 2017 and 2021, with 2020 being the highest with 3.07. The female sex presented a rate of 2.65. The age group with the highest MR is 80 and over with 141.7/100,000. For the SI by region, the XV and XII regions lead with 100%, the lowest being XI region with 83.3%. Discussion: The peak of MR for the year 2020 coincides with the Covid-19 pandemic and the highest postoperative mortality in infected patients. The SI remains above 90% in the country, except in X and XI regions, probably due to the lower availability of high complexity centers. Conclusion: Given the lack of recent mortality data for peritonitis, a local epidemiological update was carried out, with a regional comparative perspective regarding MR in the general population and in those over 50 years old.

Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis.

Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors' functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38-9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30-15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.

Increased mortality and altered local immune response in secondary peritonitis after previous visceral operations in mice.

Postoperative peritonitis is characterized by a more severe clinical course than other forms of secondary peritonitis. The pathophysiological mechanisms behind this phenomenon are incompletely understood. This study used an innovative model to investigate these mechanisms, combining the models of murine Colon Ascendens Stent Peritonitis (CASP) and Surgically induced Immune Dysfunction (SID). Moreover, the influence of the previously described anti-inflammatory reflex transmitted by the vagal nerve was characterized. SID alone, or 3 days before CASP were performed in female C57BL/6 N mice. Subdiaphragmatic vagotomy was performed six days before SID with following CASP. The immune status was assessed by FACS analysis and measurement of cytokines. Local intestinal inflammatory changes were characterized by immunohistochemistry. Mortality was increased in CASP animals previously subjected to SID. Subclinical bacteremia occurred after SID, and an immunosuppressive milieu occurred secondary to SID just before the induction of CASP. Previous SID modified the pattern of intestinal inflammation induced by CASP. Subdiaphragmatic vagotomy had no influence on sepsis mortality in our model of postoperative peritonitis. Our results indicate a surgery-induced inflammation of the small intestine and the peritoneal cavity with bacterial translocation, which led to immune dysfunction and consequently to a more severe peritonitis.

Immune Resolution Dilemma: Host Antimicrobial Factor S100A8/A9 Modulates Inflammatory Collateral Tissue Damage During Disseminated Fungal Peritonitis.

Intra-abdominal infection (peritonitis) is a leading cause of severe disease in surgical intensive care units, as over 70% of patients diagnosed with peritonitis develop septic shock. A critical role of the immune system is to return to homeostasis after combating infection. S100A8/A9 (calprotectin) is an antimicrobial and pro-inflammatory protein complex used as a biomarker for diagnosis of numerous inflammatory disorders. Here we describe the role of S100A8/A9 in inflammatory collateral tissue damage (ICTD). Using a mouse model of disseminated intra-abdominal candidiasis (IAC) in wild-type and S100A8/A9-deficient mice in the presence or absence of S100A9 inhibitor paquinimod, the role of S100A8/A9 during ICTD and fungal clearance were investigated. S100A8/A9-deficient mice developed less ICTD than wild-type mice. Restoration of S100A8/A9 in knockout mice by injection of recombinant protein resulted in increased ICTD and fungal clearance comparable to wild-type levels. Treatment with paquinimod abolished ICTD and S100A9-deficient mice showed increased survival compared to wild-type littermates. The data indicates that S100A8/A9 controls ICTD levels and antimicrobial activity during IAC and that targeting of S100A8/A9 could serve as promising adjunct therapy against this challenging disease.

Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis.

For peritonitis, a serious complication of peritoneal dialysis (PD), we investigated the relation between duration from the sign (PD effluent abnormalities) to treatment with appropriate antibiotics (ST time) and catheter removal. For 62 PD hospital patients, data of PD-related peritonitis (n = 109) were collected retrospectively. We examined ST time and PD catheter removal times using univariate and multivariate analyses. The catheter removal rate in the delayed ST time group (≥ 24 h) was higher than that in early ST time group (< 24 h) (38 vs. 16%, p = 0.02). Concomitant tunnel infection and delayed ST time were associated with catheter removal (OR [95% CI] 32.3 [3.15-329] and 3.52 [1.11-11.1]). Rates of catheter removal and re-development of peritonitis within 1 month after starting treatment were higher in the delayed ST time group (p = 0.02). PD duration at peritonitis and the first peritonitis episode were associated with delayed ST time (1.02 [1.00-1.04] and 3.42 [1.09-10.7]). Significant association was found between PD catheter removal and the start of treatment more than 24 h after appearance of abnormal effluent. Education for patients about prompt visitation at the onset of peritonitis with long PD duration might improve outcomes.

Caracterización del tratamiento quirúrgico de los tumores hepáticos sólidos / Characterization of Surgical Management of Hepatic Tumors

Introducción: La historia de la cirugía del hígado abarca 28 siglos, lo que ha permitido su evolución desde considerar al hígado como un órgano intocable hasta realizar hepatectomías complejas y trasplante hepático. Esta investigación representa el balance de 10 años en la actividad de un grupo de cirugía hepatobiliar. Objetivo: Caracterizar el tratamiento quirúrgico de los tumores hepáticos sólidos en el Centro de Investigaciones Médico-Quirúrgicas entre los años 2009 y 2019. Métodos: Se realizó un estudio de tipo observacional, descriptivo, longitudinal y retrospectivo en el que se analizaron 129 pacientes que fueron tributarios de tratamiento quirúrgico. Resultados: Los tumores malignos representaron el 73 por ciento del total, dentro de este grupo se destacan los metastásicos con 50 casos. La morbilidad de esta cirugía fue del 13 por ciento y la mortalidad operatoria del 2 por ciento. La causa de muerte identificada fue el shock séptico por peritonitis generalizada. Conclusiones: Los tumores malignos fueron los más frecuentes. Se presentó una baja morbilidad encontrándose el derrame pleural como la complicación más usual. Existe una mortalidad acorde a los valores reportados para este tipo de cirugía(AU)

Introduction: The history of liver surgery covers twenty-eight centuries, which has allowed its evolution from considering the liver as an untouchable organ to performing complex hepatectomies and hepatic transplantation. This research describes the ten years' balance in the activity developed by a hepatobiliary surgery team. Objective: To characterize the surgical management of solid hepatic tumors in the Center for Medical-Surgical Research between 2009 and 2019. Methods: An observational, descriptive, longitudinal and retrospective study was carried out, for which 129 patients who underwent surgical treatment were analyzed. Results: Malignant tumors accounted for 73 percent of the total; within this group, metastatic tumors stand out, accounting for fifty cases. Morbidity of this surgery type was 13 percent, while operative mortality was 2 percent. The cause of death identified was septic shock due to generalized peritonitis. Conclusions: Malignant tumors were the most frequent. There was low morbidity, with pleural effusion as the most common complication. Mortality is consistent with the values reported for this type of surgery(AU)

[Comparative assessment of prognostic systems for secondary peritonitis outcome]. / Sravnitel'naya otsenka sistem prognoza iskhoda vtorichnogo peritonita.

OBJECTIVE: To compare the most common prognostic systems in patients with peritonitis. MATERIAL AND METHODS: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors. RESULTS: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis. CONCLUSION: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.