Assessment of severity of peritonitis using Mannheim peritonitis index

Abstract

Introduction: Peritonitis is one of the most common problems in general surgery practice with high mortality rate. One of the reasons for high mortality is that peritonitis affects the general condition and leads to complications causing multiple organ failure, renal failure, sepsis, and postoperative ventilatory support. Early prognostic evaluation of patients with peritonitis is desirable to select high‑risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk.

Patients and Methods: Fifty cases with diagnosis of peritonitis coming to Government Medical College, Amritsar, were studied. Stratification of these patients was done according to Mannheim peritonitis index (MPI), and their outcome was examined.

Results: Mortality steadily increases with increase in MPI score. For patients with a score <21, the mortality rate was 0%; for score 21–27, it was 27.28%; and for score >27, it was 100% (P < 0.001). For patients with a score <21, the morbidity rate was 13.33%; for score 21–27, it was 65.71%; and for score >27, it was 100% (P < 0.001). Duration of pain >24 h, organ failure on admission, female sex, and feculent exudate were found to be independently significant factors in predicting the mortality among the study population. For a score of 27, the sensitivity was 66.67%, specificity was 100%, and positive predictive value for mortality is 100% at an accuracy of 94%.

Conclusion: This study proves that MPI scoring system is a simple and effective tool for assessing the morbidity and mortality in patients with peritonitis.

Keywords: Mannheim peritonitis index, morbidity, mortality, organ failure, peritonitis