Abstracts
1998 Digestive Disease Week

#1055

C3A, ENDOTOXIN AND ENDOTOXIN-NEUTROLIZING CAPACITY AS PREDICTORS OF SURVIVAL IN PERITONITIS. T. Brückner, R Urbaschek*, E Klar, Ch. Herfarth. Dept. of Surgery, University of Heidelberg, Germany; Dept. of Microbiology*, University of Mannheim, Germany.

Prognostic predictions of patients with diffuse peritonitis are difficult and prognostic biochemical parameters are missing. The aim of the present study was to assess the value of complement 3a (C3a), plasma endotoxin (ET), and endotoxin-neutrolizing capacity (ENC).

Methods: Laparotomy was performed in 60 patients with diffuse peritonitis (age 61.1 ± 17.7 years; APACHE-II-score 11.3 ± 6.0) and plasma levels of C3a, ET, and ENC were evaluated at the first 5 postoperative days. Clinical parameters of the disease (operation, time on ICU, bacteriology) and survival were assessed over 50 days postoperatively. The same parameters were evaluated for a control group (n=6). We analysed the differences between those who survived (age 59.4  ± 18.9; APACHE-II-score 9.6 ± 4.8) versus those who died (age 68.8 ± 7.8; APACHE-II-score 18.7 ± 5.0).

Results: C3a plasma levels were significantly increased in the first 3 days of the hospital stay in those patients who died compared to survivors (p<0.001). The highest predictive value of C3a (96%) was found on the first postoperative day (sensitivity 78%, specificity 86%). A preoperative APACHE-II-score < 15 predicted survival with a sensitivity of 84% and specificity of 73%. ET and ENC on the other hand were not different at any time point between the groups. Bacteriological results of blood and intraoperative cultures did not correlate with endotoxin concentrations or outcome.

Conclusion: C3a is a sensitive and specific marker in the early phase of acute peritonitis to predict survival, while ET and ENC are not. Future studies have to validate the value of C3a as a predictor of survival.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.