==== Front J Anaesthesiol Clin PharmacolJ Anaesthesiol Clin PharmacolJOACPJournal of Anaesthesiology, Clinical Pharmacology0970-91852231-2730Medknow Publications & Media Pvt Ltd India JOACP-34-25310.4103/joacp.JOACP_91_17Letters to EditorPrediction of outcome in perforation peritonitis: Sequential organ function assessment score and inflammatory mediators Arora Vandna Tyagi Asha Verma Gaurav Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, IndiaAddress for correspondence: Dr. Vandna Arora, Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India. E-mail: drvandna@gmail.comApr-Jun 2018 34 2 253 254 Copyright: © 2018 Journal of Anaesthesiology Clinical Pharmacology2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ==== Body Madam, Limited health resources of a developing country remain a logistic concern for patient care. Mortality prediction of patients may aid in optimal allocation of limited resources. Perforation peritonitis is the commonest surgical emergency in Indian subcontinent and still carries considerable morbidity and mortality.[1] We explored the utility of a clinical scoring system versus laboratory inflammatory markers for mortality prediction in patients of perforation peritonitis following emergency abdominal laparotomy. The investigated mortality predictors included sequential organ function assessment (SOFA) score, serum interleukin (IL)-10, and procalcitonin. This is a secondary analysis of 120 patients of perforation peritonitis included for effect of anesthetic interventions on their clinical outcome. The original research was undertaken only after clearance from Institutional Ethical Committee. The SOFA score (n = 120) and systemic inflammatory mediators (n = 60) were assessed preoperatively and on specified postoperative days [Table 1]. The association between various indicators and mortality was evaluated using receiver operating characteristics (ROC) analysis, exhibiting an area under the curve (AUC) for strength of the association, if any. The ROC curve analysis showed lack of any significant relationship between 28-day mortality and preoperative IL-10 and procalcitonin (P = 0.928 and 0.351, respectively) as well as postoperative IL-10 (P = 0.569). It was significant for preoperative and postoperative SOFA score (P = 0.002 and 0.000, respectively) and postoperative procalcitonin on both second and fourth day (P = 0.025 and 0.039, respectively). Table 1 Comparison of mortality predictors between survivors and nonsurvivors The AUC for preoperative and postoperative SOFA score was 0.77 (95% confidence interval (CI): 0.64–0.89) and 0.91 (95% CI: 0.83–0.99), and it was 0.78 (95% CI: 0.52–1.04) and 0.76 (95% CI: 0.53–1.00) for procalcitonin on second and fourth postoperative day, respectively. The mean values of each of these mortality predictors were significantly worse among nonsurvivors (n = 12) as compared to survivors (n = 108) (P < 0.05) [Table 1]. Based on our observations, it appears that SOFA score correlates better than any of the inflammatory mediators (IL as well as procalcitonin) with mortality in these patients. Although there are studies noting utility of clinical scores including SOFA for predicting mortality in patients with perforation peritonitis, there is no comparison with inflammatory mediators.[2] Interestingly, we noted that postoperative SOFA score is a more accurate predictor than preoperative score similar to that observed in one other study.[3] This is perhaps a result of patients response to the surgery by this time, being manifested in the first day postoperative score. The inability of procalcitonin in predicting mortality of septic patients as compared to SOFA is evidenced earlier also, as is the failure of interleukins.[45] Thus, we conclude that clinical score may still be better than laboratory markers for outcome prediction in perforation peritonitis, the commonest surgical emergency of our settings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. ==== Refs 1 Jhobta RS Attri AK Kaushik R Sharma R Jhobta A Spectrum of perforation peritonitis in India: Review of 504 consecutive cases World J Emerg Surg 2006 1 26 16953884 2 Hynninen M Wennervirta J Leppäniemi A Pettilä V Organ dysfunction and long term outcome in secondary peritonitis Langenbecks Arch Surg 2008 393 81 6 17372753 3 Copeland C Young A Grogan T Gabel E Dhillon A Quraishi S 1526: Perioperative organ dysfunction predicts mortality in critically ill patients Crit Care Med 2016 44 457 26901541 4 Ruiz-Alvarez MJ García-Valdecasas S De Pablo R Sanchez García M Coca C Groeneveld TW Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis J Intensive Care Med 2009 24 63 71 19054806 5 Haecker FM Fasler-Kan E Manasse C Fowler B Hertel R von Schweinitz D Peritonitis in childhood: Clinical relevance of cytokines in the peritoneal exudate Eur J Pediatr Surg 2006 16 94 9 16685614