Outcomes, complications, and risk factors of critical illness in patients with lower intestinal perforation

Abstract

Objectives: To describe the clinical course and outcomes of patients with lower intestinal perforation (LIP), and determine the risk factors for increasing disease severity. Methods: We reviewed the clinical records of patients with LIP admitted to the ICU after emergency surgery, between April 2006 and March 2008. We analyzed the demographic data, clinical and laboratory data, severity of illness on ICU admission, and the incidence of organ dysfunction. The outcome measures were ventilator-free days, ICU-free days (IFD), and the 28-day mortality. The risk factors for the shortening of the IFD, as a surrogate marker of increase in the severity of LIP, were assessed by Spearman's correlation and multivariate logistic regression analysis. Results: Of the 50 patients with LIP enrolled, 20 (40%) developed shock, 12 (24%) had disseminated intravascular coagulation and renal dysfunction, and 10 (20%) had acute lung injury or acute respiratory distress syndrome, within 5 days after ICU admission. The overall 28-day mortality was 6.0 %. The multivariable logistic regression analysis identified the Sequential Organ Failure Assessment (SOFA) score (odds ratio, 1.85; P = 0.025) and leukopenia (odds ratio, 20.6; P = 0.016) as independent risk factors for the shortening of IFD. Conclusions: Shock and coagulopathy are common in the acute postoperative phase in patients with LIP. The SOFA score and leukopenia on ICU admission are associated with critical illness in patients with LIP.