Predictive Significance of Hajibandeh Index

Emergency laparotomy carries a high risk of morbidity and mortality.1 Modern predictors of mortality following emergency laparotomy include age over 80, American Society of Anesthesiologists (ASA) status above 3, sarcopenia (age-related loss of skeletal muscle mass), presence of intraperitoneal contamination, and the need for a bowel resection.2-4 In order to identify patients at high risk of morbidity and mortality following emergency laparotomy, there has been increasing effort to develop and validate accurate risk-prediction models over recent years. An accurate risk-prediction model would facilitate the preoperative risk assessment, the prediction of the need for perioperative support in critical care units, objective discussion between patients and relatives and multidisciplinary decision making when deciding on operative or non-operative treatment high risk patients. Commonly used risk-prediction models for predicating mortality following emergency laparotomy include the Portsmouth-physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM)5 and the National Emergency Laparotomy Audit (NELA) score.6 Although P-POSSUM was initially the most commonly used model for predicting mortality following emergency laparotomy,7 it lost its popularity due to concerns about inaccuracy in some subgroups of patients and potential overestimation of mortality.8,9 The predictive value of the NELA score and P-POSSUM model have been compared recently and the routine use of NELA model instead of P-POSSUM has been recommended.10,11 The Hajibandeh Index (HI), which is derived from combined levels of C-reactive protein (CRP), lactate, neutrophils, lymphocytes and albumin, was developed and validated in our previous studies.12,13 It was shown that HI predicts the presence of intraperitoneal contamination in patients with acute abdominal pathology and postoperative mortality in patients undergoing emergency laparotomy.12 The HI includes levels of CRP, neutrophils and lactate as nominator considering the fact that their levels increase in presence of abdominal sepsis. It includes levels of albumin and lymphocytes as denominators because their levels decrease in presence of abdominal sepsis.12, 13 In this study we aimed to compare the performance of the HI and NELA model in predicting postoperative mortality in patients undergoing emergency laparotomy. Moreover, we aimed to reassess the performance of HI in predicting the nature and presence of peritoneal contamination.