AN ORDINAL CLINICAL RATING SCALE IN WOMEN WITH AN UNCOMPLICATED EXACERBATION OF CHRONIC INFLAMMATORY DISEASES OF THE UTERUS AND APPENDAGES

Objective. To elaborate an ordinal integrated rating scale for the symptoms of an exacerbation of chronic inflammatory diseases of the uterus and appendages (SECIDUA), by providing a detailed substantiation of the reasonability of apply ing of th is approach in gynecological care. Subjects and methods. The study covered 124 patients of reproductive age (17—45 years) who had been urgently admitted to the unit of gynecology for a diagnosed exacerbation of chronic endometritis (ICD-10 N71) or salpingooophoritis (ICD-10 N70). The proposed ordinal rating scale for SECIDUA was used to make an integrated assessment of the clinical status of the patients within the first 24 hours of their hospital stay. The SECIDUA scale provided an ordinal record of 12 symptoms that were allocated into three subscales (genital status, abdominal status, and systemic inflammatory response syndrome). To prove the objectivity of the scores of the scale and its subscales, the findings were compared with the results of clinical and laboratory studies of peripheral blood and a pathohistological examination of endometrial biopsy specimens. Changes in SECIDUA scores were additionally evaluated during standard treatment. Results. There was a high internal consistency (validity) of both the SECINDUA scale as a whole (Cronbach’s alpha coefficient, 0.887) and its individual subscales (Cronbach’s alpha coefficient, 0.778 to 0.993). The scores of the SECINDUA scale and each of three components of its subscales were directly correlated with the spread of purulent dissolution foci and with the values of polynuclear and lymphocyte infiltration in the patients’ endometrial biopsy specimens (Spearman’s correlation coefficient, 0.20 to 0.68; р=0.02—<0.0001). The similar trend was seen in the level of proinflammatory cytokines, the values of leukocytosis, the proportion of stab neutrophils, the functional state of neutrophil granulocytes, and the concentration of IgM (Spearman’s correlation coefficient, 0.20 to 0.69; р=0.02—<0.0001). Standard drug treatment for chronic endometritis and salpingo-oophoritis resulted in a considerable reduction in SECINDUA scores. Conclusion. The SECINDU scale has a high internal consistency and a sufficient validity for practical application. Its application may be useful for the objective characterization of the clinical efficiency of new approaches to treating inflammatory gynecological diseases.

exacerbation of chronic inflammatory diseases of the uterus and appendages, ordinal symptom rating scale, clinical and laboratory blood study, endometrial pathohistological examination