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. 2023 Oct-Dec;13(4):9-17.
doi: 10.4103/jwas.jwas_307_22. Epub 2023 Sep 16.

Typhoid Intestinal Perforation Prognostic Score in Poor-Resource Settings

Harissou Adamou  1 , Ibrahim Amadou Magagi  1 , Oumarou Habou  1 , Ousseini Adakal  2 , Maman Bachir Abdoulaye  2 , Amadou Magagi  3 , Maman Laoul Hassane  3 , Lassey James Didier  4 , Rachid Sani  4
Affiliations

Typhoid Intestinal Perforation Prognostic Score in Poor-Resource Settings

Harissou Adamou et al. J West Afr Coll Surg. 2023 Oct-Dec.

Abstract

Background: Mortality from peritonitis due to typhoid intestinal perforation (TIP) in sub-Saharan Africa is high.

Objectives: This study aimed to determine the predictive factors of mortality, propose a prognostic score, and determine the appropriate surgical treatment for TIP in low-resource settings.

Materials and methods: This was a retrospective data collection of peritonitis due to TIP admitted at Zinder National Hospital from 2014 to 2021. To build a typhoid intestinal perforation prognostic score (TIPPS), patients were randomised into two groups: a score-building group and a validation group. Univariate and multivariate analyses were performed to identify risk factors of mortality. The value of P <0.05 was assigned significant for all analyses.

Results: TIP accounted for 52.4% (n = 1132) of all cases of peritonitis (n = 2159). The median age was 12 years. Rural provenance represented 72.2% (n = 817). Deaths accounted for 10.5% (n = 119). The factors influencing mortality were respiratory rate ≥24/min (odds ratio [OR] = 2.6, P = 0.000), systolic blood pressure <90 mmHg (OR = 0.31, P = 0.002), serum creatinine >20 mg/L (OR = 2.6, P ≤ 0.009), haemoglobin (OR = 2.1, P = 0.000), comorbidity (OR = 3.5, P = 0.001), the American Society of Anesthesiologists score IV&V (OR = 3.3, P = 0.000), admission and management delay > 72 h (OR = 3.2, P = 0.001), and a number of perforations (OR = 2.4, P = 0.0001). These factors were used to build a "TIPPS" score, which ranged from 8 to 20. The risk of mortality was associated with increased TIPPS. The performance of this score was good in the two groups (area under receiver operating characteristic > 0.83). According to the severity and mortality risk of TIP, we classified TIPS into four grades: grade I (low risk: 8-10), grade II (moderate risk: 11-13), grade III (high risk: 14-16) and grade IV (very high risk: 17-20).

Conclusion: The TIPPS is simple. It can describe the severity of the disease and can predict the risk of death. The study highlights the importance and impact of timely and adequate perioperative resuscitation in more complicated cases.

Keywords: Intestinal; perforation; peritonitis; prognosis; scoring; typhoid.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Intraoperative macroscopic aspects of intestinal perforation of typhoid origin (black arrows)
Figure 2
Figure 2
Performance of the prognostic score—(A) SBG (AUC =0.834) and (B) VG (AUC = 0.878). (C) The relationship between the TIPPS and the mortality both in the building and validation groups (coefficient of determination R2 = 0.9569). AUC: area under curve
See this image and copyright information in PMC

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