PREDICTION OF THE RISK OF SEVERE PERITONITIS IN ACUTE INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY

Abstract

Abstract. Introduction. One of the most challenging problems of surgery is peritonitis, which can be a complication of acute inflammatory diseases of the abdominal cavity and is accompanied by high mortality. The development of prognostic models of peritonitis is a modern task of precision medicine. Aim. To determine the risk of severe peritonitis in patients undergoing surgery for acute abdominal diseases. Materials and methods. The study involved 139 patients who had been operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). The rs1927911, rs2149356 and rs4986790 polymorphisms were determined by polymerase chain reaction using the Gene Amp® PCR System 7500 amplifier (Applied Biosystems, USA) and TaqMan Mutation Detection Assays Life-Technology (USA). Statistical processing of the study results was performed using the EZR v.1.54 software (Vienna, Austria). Results. Univariate regression analysis revealed a higher (p=0.008) risk of severe peritonitis for men (OR 2.56; 95% CI 1.29-5.11) compared with women; an increase (p=0.031) in the risk of severe peritonitis with patient age (OR 1.02; 95% CI 1.00-1.05). The risk of severe peritonitis increased (p<0.05) with higher admission temperature, heart rate, international normalised ratio, and leukocytosis. A reduction (p=0.009) in the risk of severe peritonitis was found with a higher prothrombin index (OR 0.95; 95% CI 0.92-0.99). In addition, a decrease (p=0.015) in the risk of severe peritonitis was found in carriers of the G/A+A/A rs1927911 heterozygote of the TLR4 gene (OR 0.42; 95% CI 0.21-0.84) compared with carriers of the ancestral G/G genotype. The multivariate model included the rs1927911 genotype, age, sex, heart rate, and leukocytosis (AUC=0.83; 95% CI 0.75-0.89; p<0.001); the model sensitivity was 68.4% (95% CI 56.7%-78.6%), and specificity was 88.9% (95% CI 78.4%-95.4%). Conclusion. Thus, prognostic risk factors for severe peritonitis were identified and a mathematical model for its prediction was developed using clinical, laboratory and genetic parameters.