Invited Commentary

A variety of scoring systems have been used to predict the risk for mortality in patients with secondary bacterial peritonitis. The APACHE II score has been the most common scale used, and Koperna and Schulz report results similar to those of an earlier study.¹ Of importance to note is that their study demonstrates that longitudinal scoring using APACHE II is not helpful, and they propose using a scoring system modified from one described by Goris et al² to predict the development of multiple organ system failure, which continues to be a harbinger of the need for reoperation. Except for diffuse peritonitis, the additional factors predictive for reoperation described in this report are included in the other scales; thus, their use as individual predictors of treatment failure is redundant. This article suggests that the sequential use of these two scoring systems is helpful to select which patients have failed treatment