Clinical characteristics and prognostic factors of severe intra-abdominal infection due to gastrointestinal perforation: a retrospective cohort study

Gastrointestinal perforation is a medical emergency. We aimed to explore clinical characteristics and prognostic factors in patients with severe intra-abdominal infection due to gastrointestinal perforation.

In this retrospective cohort study, we reviewed patients diagnosed with severe intra-abdominal infection due to gastrointestinal perforation between January 2020 and January 2025. Demographics, clinical information, laboratory test results, management approach, 28-day mortality, and 180-day survival rate were recorded. Through regression probability analysis, multivariate logistic regression, Kaplan-Meier survival analysis, and Cox regression, we systematically analyzed patient clinical characteristics and determined the variables impacting their prognosis.

A total of 108 eligible patients were included, with a 28-day mortality rate of 24.1% and a 180-day survival rate of 59.3%. Smoking history, diabetes, cardiovascular disease, rheumatic immune disease, malignant tumors, presence of elevated procalcitonin, the Acute Physiology and Chronic Health Evaluation II score, Mannheim Peritonitis Index score, low serum albumin and low prealbumin, infection from the stomach and duodenum, and fungal infection were independent risk factors while empirical use of antifungal drugs was associated with reduced 28-day mortality (all p < 0.05). Diabetes (p = 0.047), malignant tumors (p = 0.016), initial serum albumin level below 30 g/L, prealbumin level below 300 mg/L, infection source control time exceeding 12 h (p < 0.001), and enteral nutrition initiation time exceeding 6 days (p = 0.001) were independent risk factors for 180-day survival status. Compared with patients whose infection originated from the jejunum, ileum, cecum, or colon, infection from the stomach and duodenum was an independent risk factor for 180-day survival status.

Patients with severe intra-abdominal infection due to gastrointestinal perforation had poor prognosis. Multiple variables were identified to be associated with 28-day mortality and 180-day survival. Early infection source control, appropriate enteral nutrition initiation could improve prognosis.Early and timely empirical antifungal treatment in addition to other necessary interventions might be considered in these patients.