Peritonitis [2,3]. The prognosis remains poor despite development

Peritonitis is defined as an inflammatory process involving the serosal lining of the abdominal cavity and the visceral surface. The pathology includes localized or generalized microbial infG1 ection, depending on the source are classified into three categories. Primary peritonitis is an infection, often monomicrobial, of the peritoneal fluid without visceral perforation. Secondary peritonitis arises subsequent to the loss of integrity of a hollow viscus and is the most common form of peritonitis encountered. Tertiary peritonitis develops following the treatment of secondary peritonitis either due to the failure of the host inflammatory response or due to G2 G3 G4 G5 superinfection) 1.

Secondary peritonitis usually presents as acute generalized peritonitis which is a potentially life-threatening condition. It is a common surgical emergency in most of the general surgical units, across the world. It is often associated with significaG6 nt morbidity and mortality 2,3. The prognosis remains poor despite development in management strategies. It is essential that a grading system should be implemented for early identification of patients with severe peritonitis in order to select them for intensive management. Many scoring systems are available that helps to measure & stratify the condition of critically ill patients and thus helps the clinicians in better resource allocation as per the needs of the patient and feasibility of outcome expected 4.

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The Acute physiology and chronic health evaluation II (APACHE II) score is a common score globally and the most used ICU scoring system in the USA. It comprises twelve different physiological measurements, age, and previous health status, and was originally designed to categorize ICU patients according to risk. The system gives an increasing amount of points for extreme values (high or low), between 0 (36.0°C -38.4°C) and 4 (?41°C and ?29.9°CG7 )5. This score was later implemented in surgical patients to predict clinical outcome. Agarwal A et al. Int Surg J. 2017, reported that APACHE II score correlates well with clinical outcome, and hospital stay in patients with perforation peritonitis 6. In another study, Delibegovic S et al. 7 evaluated APACHE II, SAPS I, Sepsis score, MOF, TISS-28 and MPI scoring systems in the prediction of the outcome in patienG8 ts with perforative peritonitis, and concluded that APACHE II is superior in the prediction of the outcome to other tested scoring systems.G9  Therefore in this study, we are validating the APACHE II score as G10 G11 an early indicator of adverse outcomes in peritonitis patients in our population.G12