# Predictive Impact of Peritoneal Computed Tomography Attenuation Values for the Severity of Upper Gastrointestinal Perforation

## TL;DR

This study shows that CT scan values of the peritoneum can predict the severity of peritonitis in patients with upper gastrointestinal perforation.

## Contribution

The study introduces peritoneal CT attenuation values as a novel objective measure for assessing peritonitis severity in UGI perforation cases.

## Key findings

- Lower peritoneal CT attenuation values were associated with higher mortality and worse clinical scores.
- Peritoneal CT values correlated with C-reactive protein levels and time since symptom onset.
- SOFA scores were significantly associated with peritoneal CT attenuation values in multivariate analysis.

## Abstract

This study aimed to evaluate the peritoneal computed tomography (CT) attenuation values and investigate their predictive impact for the severity of peritonitis in patients with upper gastrointestinal tract (UGI) perforations.

Overall, 112 consecutive patients with UGI perforations who underwent plain CT were included in this study. Peritoneal CT attenuation values expressed in Hounsfield units (HUs) were measured on a workstation and investigated in relation to laboratory data obtained on admission, severity of illness, and hospital mortality.

Peritoneal CT attenuation values were significantly negatively correlated with the Acute Physiology and Chronic Health Evaluation II (p < 0.01, R2 = 0.17) and sequential organ failure assessment (SOFA) (p < 0.01, R2 = 0.30) scores. Peritoneal CT attenuation values of hospital nonsurvivors (n = 7, 12.4 ± 11.0 HU) were significantly lower than those of hospital survivors (n = 105, 34.3 ± 15.8 HU). There was a significant negative correlation between peritoneal CT attenuation values, serum C-reactive protein levels (p < 0.01, R2 = 0.11), and the time after the onset of abdominal pain (p < 0.01, R2 = 0.08). Multivariate analysis revealed that the SOFA score was significantly associated with peritoneal CT attenuation values.

Evaluation of peritoneal CT attenuation values in patients with UGI perforation is simple and can be used to objectively assess the severity of peritonitis, which can serve as a reference for treatment strategies.