Abstract
Background: Despite advances in diagnosis, surgery, antimicrobial therapy and intensive care support, secondary peritonitis remains a potentially fatal condition especially if not treated at the earliest. Early assessment by scoring systems will influence the management and prognosis.
Aim: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the Mortality and Morbidity in patients with hollow viscus perforation peritonitis.
Materials and Methods: Prospective study of 100 patients with peritonitis due to hollow viscus perforation who presented to Kempegowda Institute of Medical Sciences
HOSPITAL, BANGALORE from October 2014 to August 2016. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software.
Results: The overall mortality and morbidity was 19% and 57% respectively. MPI scores of ≤ 20, 21-29, and ≥ 30 had a mortality of Nil, 4%, and 15% respectively. MPI score of 30 had highest sensitivity of 100% and specificity of 91.43% in predicting mortality, 80.65% sensitivity and 75.83% specificity for morbidity. MPI score of > 25 were associated with 6.45 times higher risk of mortality (p=0.03), 5.72 times higher risk of morbidity (p=0.005) compared to patients with MPI score ≤ 25.
Conclusion: The MPI is a specific score, which has a good accuracy and provides an easy way to handle with clinical parameters, allowing the prediction of the individual prognosis of patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice.
References
- Bohnen J, Boulanger M, Meakins JL, Mclean APH. Prognosis in generalized peritonitis: relation to cause and risk factors. Arch Surg. 1983;118:285-90.
- Giessling U, Petersen S, Freitag M, Kleine-Kraneburg H, Ludwig K. Surgical management of severe peritonitis. Zentralbl Chir. 2002;127:594-97.
- Farthmann EH, Schoffel U. Principles and limitations of operative management of intra-abdominal infections. World J Surg. 1990;14:210-17.
- Ponting GA, Sim AJW, Dudley, HAF. Comparison of local and systemic Sepsis in predicting survival. Br J Surg. 1987;74:75052.
- Bion J. Outcome in Intensive care. BMJ. 1993;307:953-54.
- Knaus WA, Drapper EA, Wagner DP, Zimmerman JE. APACHE severity of disease classification system. Crit Care Med. 1985;13:818-29.
- Kologlu M, Elker D, Altun H, Sayek I. Validation of MPI and PIA II in two different groups of patients with secondary peritonitis. 2001;48:147-51.
- Bosscha K, Reijnders K, Hulstaert PF, Algra A, van der Werken C. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg. 1997; 84(11):1532-34.
- Wacha H, Linder MM, Feldman U, Wesch G, Gundlach E, Steifensand RA. Mannheim peritonitis index – prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theoretical Surg. 1987;1:169-77.
- Correia MM, Thuler LCS, Velasco E, Vidal EM, Schanaider A. Peritonitis Index in oncologic patients. Revista Brasileira de Cancerologia. 2001;47(1):63-68.
- Billing A, Frölich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg. 1994;81:209-13.
- CS Agrawal, M Niranjan, S Adhikary, BS Karki, R Pandey and PR Chalise. Quality assurance in the management of peritonitis: A prospective study. Nepal Med Coll J. 2009; 11(2):83-87.
- F Ntirenganya, G Ntakiyiruta, I Kakande. Prediction of Outcome Using the Mannheim peritonitis Index in Patients with Peritonitis at Kigali University Teaching Hospital. East Cent Afr J Surg. 2012;17(2):52-64.
- Mathikere Lingaiah Ramachandra, Bellary Jagadesh, Sathees BC Chandra. Clinical study and management of secondary peritonitis due to perforated hollow viscus. Arch Med Sci. 2007;1:61-68.
- Notash AY, Salimi J, Rahimian H, Fesharaki MH, Abbasi A. Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis. Indian Journal of Gastroenterology. 2005; 24(5):197-200.
- Demmel N, Muth G, Maag K, Osterholzer G. Prognostic scores in peritonitis: the Mannheim Peritonitis Index or APACHE II? Langenbecks Arch Chir. 1994;379(6):347-52.
- Mulari K, Leppäniemi A. Severe secondary peritonitis following gastrointestinal tract perforation. Scand J Surg. 2004;93(3):204-8.
- S Biondo, E Ramos, D Fraccalvieri, E Kreisler, J Martí Ragué, E Jaurrieta. Comparative study of left colonic peritonitis severity score and Mannheim peritonitis index. Br J Surg. 2006;93(5):616–22.
- Kusumoto Yoshiko, Neyagawa Masayuki, et al. Study of Mannheim Peritonitis Index to Predict Outcome of Patients with Peritonitis. Japanese Journal of Gastroen-terological Surgery. 2004;37(1):7-13.
- Qureshi AM, Zafar A, Saeed K, Quddus A. Predictive power of Mannheim peritonitis index. J Coll Physicians Surg Pak. 2005;15(11):693-6.
- Malik AA, Wani KA, Dar LA, Wani MA, Wani RA, Parray FQ, et al. Mannheim Peritonitis Index and APACHE II - prediction of outcome in patients with peritonitis. Ulus Travma Acil Cerrahi Derg. 2010;16(1):27-32.
Corresponding Author
Dr Satya Vani K