The Peritonitis Index of Altona II (PIA II) was developed to evaluate patients with intra-abdominal infections. Discriminant analysis was used to rank variables and to assign a weighting value, according to their ability to separate patients into survivors and nonsurvivors. The index was developed at Allgemeines Krankenhaus Altona in Hamburg, Germany.
Risk factors:
(1) gender
(2) age
(3) duration of peritonitis
(4) congestive heart failure
(5) diabetes mellitus
(6) leukocyte (WBC) count
(7) serum creatinine
(8) diffuse peritonitis
(9) peritonitis due to mesenteric infarction
(10) intestinal strangulation
(11) site of perforation (peptic ulcer, appendix, colon)
|
Parameter |
Finding |
Weighting |
|
gender |
male |
-0.61 |
|
|
female |
0 |
|
age |
> 60 years |
-0.38 |
|
|
<= 60 years |
0 |
|
duration of peritonitis |
> 48 hours |
-0.40 |
|
|
<= 48 hours |
0 |
|
congestive heart failure |
present |
-0.47 |
|
|
absent |
0 |
|
insulin dependent diabetes mellitus |
present |
-1.36 |
|
|
absent |
0 |
|
leukocyte count |
> 26,000 per µL |
-2.47 |
|
|
5,000 – 26,000 per µL |
0 |
|
|
< 5,000 per µL |
-2.47 |
|
serum creatinine |
> 4 mg/dL |
-0.75 |
|
|
<= 4 mg/dL |
0 |
|
diffuse peritonitis |
present |
-0.34 |
|
|
absent |
0 |
|
peritonitis due to mesenteric infarction |
present |
-4.19 |
|
|
absent |
0 |
|
intestinal strangulation |
present |
-2.74 |
|
|
absent |
0 |
|
peptic ulcer perforation |
present |
0.49 |
|
|
absent |
0 |
|
perforated appendicitis |
present |
0.62 |
|
|
absent |
0 |
|
colonic perforation |
present |
0.77 |
|
|
absent |
0 |
where:
• The original tables refer to creatine rather than creatinine.
PIA II index =
= SUM(weighting for all of the risk factors) + 2.02
Interpretation:
• minimum score: < -8.0
• maximum score: 3.9
• A high score is associated with a low mortality rate (high survival).
|
PIA II Index |
Mortality in Postoperative Group |
Mortality in Other Group |
|
> 2 |
0 |
0 |
|
0 – 2 |
11.6% |
5% |
|
-2 to 0 |
55.5% |
55.3% |
|
< -2 |
76.9% |
88.8% |
from Kologlu et al (2001), Figure 2, page 148.
Performance:
• Wittman et al (1987) found that the score correctly classified 89% of patients in the test group and 81% of a control group.
• Ohmann et al found that the APACHE II score was superior in its discriminatory ability and reliability (although the graph of PIA II scores in Figure is opposite to the data above).
Specialty: Infectious Diseases, Surgery, general, Gastroenterology
