Mannheim Peritonitis Index Score Research Articles

Study of Mannheim peritonitis index for predicting morbidity and mortality in patients of hollow viscous perforation: In a tertiary care hospital of Eastern India

Background: Peritonitis is the inflammation of peritoneum, the serosal membrane that lines the abdominal cavity and organs inside. The hollow viscous perforation (HVP) is one of the most common surgical emergencies encountered by surgeons on a daily basis. Mannheim Peritonitis Index (MPI) is a simple and effective method in predicting the morbidity of patients with HVP. Aims and Objectives: This study attempts to evaluate the prognostic value of MPI scoring system in patients with peritonitis due to HVP. Materials and Methods: This is a clinical, prospective, and observational study. There were 50 patients with HVP (stomach, duodenum, ileum, and appendix) admitted in Srirama Chandra Bhanja Medical College and Hospital from March 2021 to October 2022 included in the study. Necessary data were collected; MPI score was calculated for each patient and analyzed. Results: The number of post-operative complications, duration of intensive care unit, and hospital stay proportionately increased with the MPI score. Out of the eight variables used in this scoring system, duration of pain, intraperitoneal fluid and organ failure on admission carried more significance in predicting the morbidity in the post-operative period than the other variables. Conclusion: MPI is a simple and effective method in predicting the morbidity of patients with HVP and to assess it as a clinical tool in stratifying these patients according to individual surgical risk.

Evaluation of Mannheim's Peritoneal index score (MPI) for predicting mortality in patients with peritonitis.

Introduction: Despite latest development the diagnosis and prognosis of acute intraperitoneal infection is still offer a challenge. Different scoring algorithms have been formulated to grade the severity and decision making.Objective: To document reliability of Mannheim Peritonitis Index as a criterion for prediction of mortality after acute intraperitoneal infectionMethodology: This cross-sectional study was conducted at department of Surgery; Civil Hospital Karachi/Dow University of Health Sciences during December 2019 to June 2020. Total 200 patients aged 16 to 55 years from either gender, presenting with peritonitis were enrolled. Patients were evaluated using Mannheim Peritonitis Index (MPI) score for mortality taking real mortality within 7 days as gold standard.Results: The mean age was 37.3 ±9 years with male (71%) dominance, while mean MPI score was 27.12 ±7.1. The sensitivity was 91.8 %, specificity was 84.4 %, while positive predictive and negative predictive values and diagnostic accuracy values were 87.8 %, 89.4 % and 93% respectively.Conclusion: Several scoring systems are utilized to evaluate and stratify patients in overcrowded emergency department which is crucially important for selection of patients who need early clinical decisions. MPI scoring index is the specific and simply accessible in such condition to predict the mortality.Keywords: Mannheim Peritonitis Index, acute intraperitoneal infection, In-hospital mortality, Diagnostic accuracy.

The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India.

Introduction Acute secondary peritonitis due to hollow viscus perforation is a life-threatening surgical condition with significant morbidity and mortality, depending on the severity with outcomes that differ in the Western and developing world. Various scoring systems have been developed to assess the severity and its relation to morbidity and mortality. We conducted this study to evaluate the role of the Mannheim peritonitis index (MPI) in predicting outcomes in perforation peritonitis patients in a rural hospital in India. Materials and methods A prospective study of 50 patients with hollow viscus perforation with secondary peritonitispresented to the emergency department, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, from 2016 to 2020. Each operated patient was scored according to the MPI to predictmortality. Results The majority of the patients were discharged uneventfully and about 16% (8/50) of the patients expired. The patients with an MPI score of more than 29 had maximum mortality of 62.5%. Mortality was seen in 37.5% of the patients with MPI scores between 21 and 29, whereas no mortality was recorded in patients with an MPI score of 21. Higher mortality was associated with age greater than 50 years (p=0.007), the presence of malignancy (p=0.013), colonic perforation (p=0.014), and fecal contamination (p=0.004). There was no significant correlation with gender (p=0.81), the presence of organ failure (p=1.6), delayed presentation, i.e., preoperative duration >24 hours (p=0.17), and the presence of diffuse peritonitis (p=0.25). Conclusion MPI is a specific, easily reproducible, and less cumbersome scoring method for predicting mortality in patients with hollow viscus perforation (secondary) peritonitis with minimal laboratory investigations. Higher scores correlate with a poorer prognosis and need intensive management, making use of MPI in clinical practice relevant and beneficial, especially in resource-poor settings.

A PROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE MANNHEIM PERITONITIS INDEX IN PREDICTING DIFFERENT OUTCOMES OF PATIENTS WITH PERITONITIS

Background: Perforation peritonitis is one of the most common surgical emergency case which is encountered in the surgical emergency department,with very high morbidity and mortality. The decision making is very important that which patient need urgent surgery and which patient need resuscitation and surgical intervention later on.To help this there are several scoring system made one of which is Mannheim peritonitis index. In this study we tried to evaluate it and its usefullness in peritonitis patients. Patients and Methods: A prospective observational study conducted over 300 patients of peritonitis admitted in the Surgery Department of LLR Hospital, GSVM Medical College, Kanpur after taking proper consent in which Mannheim peritonitis index was evaluated. From the Results: total 300 patients 233(78%) were men and 40 were expired(13.3%).In expired patients mean MPI score was 29.05 SD7.01. Patients who were alive had mean MPI score 20.79 SD6.1, 194(65%) patients hospitalised for less than 10 days, 106(33%) patients were hospitalised for more than 10 days. In the patients who hospitalised for more than 10 days mean MPI score was 27.68 SD7.43, 96(32%) patients needed ICU care. Mean MPI score in patients who needed ICU care was 30 SD5.93, 15(5%) patients had anastomotic leak postoperatively,In anastomotic leak patients mean MPI score was 27.5 SD6.34, 72(24%) patients had wound dehiscense, Mean MPI score in the patients who had wound dehiscence was 28.03 SD7.008. Patient who faced no morbidity, Had mean MPI score of 12.8 SD3.5. Mortality in male patients was 12.44% and in female patients was 16.41%. Conclusion: Mannheim peritonitis index proved to be a good predictor of morbidity and mortality in the patients of peritonitis, With higher the Mannheim peritonitis index score higher the mortality and morbidity,but has limitations in prediction of some morbidites ljke anastomotic leak.

Mannheim Peritonitis Index as a Predictor of Post-operative Complications, Mortality and Duration of Hospital Stay in Patients with Peritonitis due to Hollow Viscus Perforation: A Prospective Cohort Study

Introduction: Peritonitis due to hollow viscus perforation is a common surgical emergency and can be life-threatening. Patients who undergo surgery for peritonitis require extensive counselling to fully understand the nature of the disease, the need for surgery, post-operative complications and the duration of hospital stay. Hence, scoring systems are necessary to determine the severity of the disease to provide sufficient prognostic data. Aim: To evaluate the Mannheim Peritonitis Index (MPI) scoring system as a predictor of post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation. Materials and Methods: The prospective cohort study was carried out in 50 diagnosed cases of perforation peritonitis admitted at the centre during the study period from November 2017 to October 2018. MPI was calculated for each patient, following which they were stratified into three risk groups- 1, 2 and 3 with scores of ≤20, 21-29 and ≥30, respectively. Post- operative complications, mortality, and duration of hospital stay were analysed. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software 24.0. Results: Out of 50 patients included, 36 were male and 14 were female with a mean age of 41.14 years. A total of eight patients suffered mortality. The incidence of mortality in risk Group-1 was 0 out of 29 patients (0%), risk Group-2 was 3 out of 13 patients (23.1%) and risk Group-3 was 5 out of 8 patients (62.5%), respectively and hence MPI was a useful indicator of prediction of mortality in perforation peritonitis patients. The risk factors which had a higher significance in predicting mortality were found to be, organ failure at presentation and the nature of intra-peritoneal exudate with a p-value of 0.029 and <0.001, respectively. In 29 patients, there were no complications and 13 patients had a single complication, 8 patients had multiple complications. The incidence of multiple post-operative complications in a patient in risk Group-1, 2 and 3 were 1 (12.5%), 2 (25%) and 5 (62.5%) patients, respectively. The number of complications in a patient increased as the MPI score increases. Dispersion of duration of hospital stay in discharged patients according to MPI score using Pearsons’s correlation, showed statistical significance with the value of r being 0.6214, the p-value being 0.000011. The duration of hospital stay of patients who were discharged, increased as the MPI score increased. Conclusion: MPI was effective in predicting post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation and hence can be used as an effective tool to facilitate counseling and educate the patient and relatives regarding the expected course of the disease in that particular patient.

Simplified acute physiology score II and Mannheim peritonitis index are associated with in-hospital mortality in patients with abdominal sepsis admitted to ICU.

The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality. We conducted a single-center case-control study. Adult patients with abdominal sepsis were included from May 2015 to May 2020. Baseline characteristics, laboratory parameters, SAPSII, MSI, and MPI scores at admission were collected. A principal component (PC) analysis was applied to evaluate variable interactions. In-hospital mortality risk was determined through logistic regression models. One hundred and twenty-seven patients were identified, 60 of which were included for analyses. Non-survivors (48.4%) had a higher frequency of hypertension, lactate and MPI, and lower BE and alactic BE levels. Eight PCs were obtained, PC1 being a linear combination of pH, AG, cAG, alactic BE, bicarbonate, and BE. MPI (OR = 9.87, 95% CI: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, 95% CI: 1.01-1.14, p = 0.01), and PC1 (OR = 2.13, 95% CI: 1.12-4.76, p = 0.04) were significantly associated with mortality in univariate analysis, while MPI (OR = 10.1, 95% CI: 3.03-40.06, p = 0.0003) and SAPSII (OR = 1.07, CI95%: 1.01-1.14, p = 0.02) remained significant after adjusting for age and sex. MPI and SAPSII were associated with mortality, although the interaction of laboratory parameters was not.

A prospective study evaluating utility of Mannheim peritonitis index in predicting the outcome of peritonitis following hollow viscus perforation

Background: Gastrointestinal perforations account for about 25% of acute abdominal emergencies. Despite advancements in diagnosis, management and critical care of patients due to hollow viscus perforation, the prognosis remains worrisome as the overall mortality rate due to perforation peritonitis is 6 to 27%. The aim of the study was to evaluate the prognostic value of Mannheim peritonitis index scoring system in patients with perforation peritonitis, to assess it as a clinical tool in stratifying these patients according to individual surgical risk.Methods: A prospective study of 58 patients with peritonitis due to non-traumatic hollow viscus perforation who presented to the department of general surgery, Jorhat medical college hospital, Jorhat from June 2020 to May 2021. The structured scoring system of MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. The study patients were divided into three groups according to MPI score. Group 1: MPI score less than 21, group 2 MPI score in between 21-29, and group 3 MPI score more than 29. Data was analysed for predicting the outcome by using IBM statistics SPSS software 21.0 version.Results: MPI scores of <21, 21-29, and >29 had a morbidity of 27.6%, 51.7% and 20.7% respectively. No mortality in patients with MPI less than 21; whereas those patients with MPI score more than 29 had the highest mortality rate of 60%. Patient with MPI score 21 to 29 had mortality rate of 40%. The number of post-operative complications, duration of ICU and hospital stay proportionately increased with the MPI score.Conclusions: MPI is an independent, disease specific, easier to calculate with very minimum basic investigations, simple and effective objective scoring system in predicting the morbidity and mortality.

Open versus laparoscopic technique in peptic ulcus perforation, how effective are score systems?Single-center experience and literature review.

One of the most common peptic ulcer complications is perforation (PUP) which also remains an important cause of morbidity and mortality. In this study, it was aimed to compare the results of patients who had similar pre-operative scoring index results (Boey, Charlson Comorbidity Index (CCI) and Mannheim Peritonitis Index (MPI), and type of surgery. Pre-operative Boey, CCI, and MPI scores were calculated by retrospectively examining the files of patients who were operated under emergency conditions with the diagnosis of PUP. The patients divided into two groups those who underwent laparoscopic surgery/Group-1 and open surgery/Group-2. There was no statistical difference between the groups in terms of demographic data, hospital admission time, and length of hospital stay. The operation time was found to be longer in the laparoscopic group (110,2 SD20,6/75-150 min) than open group (54,2 SD15,7/30-120 min) (p<0.001). Morbidity was less in laparoscopic group (4% versus 14.6%) (p<0.001). The laparoscopic method may be used safely in PUP due to the lower post-operative complication rates and known advantages of minimally invasive surgery.

Effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: To study the spectrum and prognostic factor in perforation peritonitis. To evaluate the outcome of patients and identification of high risk patients using Mannheim peritonitis index.Methods: 80 patients with hollow viscous perforation admitted in the Dept. of Surgery Adhichuchanagiri Institute of Medical sciences from January 2019 to June 30 2020 were included in the study. Necessary data was collected; MPI score was calculated for each patient and analysis done.Results: The number of post-operative complications, hospital stay and mortality proportionately increased with the MPI score. In our study Age &gt;50 years, Organ failure at admission pre operatively and MPI scoring found to be statistically significant. Out of the 8 variables used in this scoring system, age more than 50 years and organ failure on admission carried more significance in predicting the morbidity and mortality in the post operative period than the other variables.Conclusions: Mannheim peritonitis index is a simple and effective method in predicting the mortality and morbidity of patients with hollow viscous perforation.

To Study the Efficacy of Mannheim’s Peritonitis Index in Patients of Perforation Peritonitis

Introduction-Despite advances in critical care medicine, prognosis in peritonitis due to hollow viscousperforation remains poor especially when associated with multi-organ dysfunction. Various grading systemsare available to analyze and stratify patients by different parameters and predict outcome. In a prospectivenon-randomized observational study, the efficacy of Mannheim peritonitis Index (MPI) was analyzed inpredicting the outcome in patients who were treated for peritonitis due to hollow viscous perforation.Method -A prospective study to assess the efficacy of Mannheim’s peritonitis index in 100 patientswhopresented with perforation peritonitis from August 2016 to July 2017 in LLRM medical college, Meerut.Result -100 patients were included in the study , patients were divided into 3 categories according to MPIscore 29. In category 1 mortality was around8.33%,category 2 had 28.8% mortalityand category 3 had 53.7% mortality.Thus increase in MPI score due to cumulative effect of all 8 parametersresulted in increased risk of mortality in perforation peritonitis .Conclusion – In this study all the parameters of Mannheim’s peritonitis index behave in expected manner,but there were no patient of malignancy and all patient were having generalized peritonitis and femalepatients were only 20. Therefore this study should be done for longer period of time to access all parameterof MPI score.

EFFICACY OF MANNHEIM PERITONITIS INDEX IN PREDICTION OF MORTALITY AND MORBIDITY IN PATIENTS WITH SECONDARY PERITONITIS

Background: Acute generalized peritonitis following hollow viscus perforation is a potentially life threatening condition leading to a cascade of infective processes, sepsis, disseminated intravascular coagulation, multi organ failure and death in the presence of irreversible damage to the vital organs. Grading the severity of acute peritonitis can contribute in better management of patients with perforation peritonitis. The Mannheim Peritonitis Index (MPI) scoring system takes into account various characteristics like age of the patient, gender, duration of peritonitis, organ failure, Malignancy, colonic sepsis, extent of spread and character of the peritoneal uid. The Objective of this study was to determine the Prognostic value of MPI in patients with Secondary Peritonitis. Methods: In this study conducted at SMI Hospital, Dehradun, Over a period of 1 year, all patients presenting with features of Peritonitis due to hollow viscus perforation were included. MPI score of all the patients were calculated and categorized into three groups; less than 21, 21-29 and more than 29. Mortality of patients from each group was calculated and predictive value of each factor was determined. Results:Total 150 patients were included in this study. There were total 21 mortalities. For patients with a score &lt;21, the mortality rate was 0%; for score 21–29, it was 4.3%; and for score &gt;27, it was 67.9% (P &lt; 0.001). Age&gt; 50 years, presence of organ failure, malignancy, presentation after 24 hours, generalized peritonitis and Fecal exudate were associated with higher mortality rates. Conclusions: MPI is a simple and useful scoring system to determine the prognosis and complications in patients with perforation peritonitis.

Risk Factors for Enterococcal Intra-Abdominal Infections and Outcomes in Intensive Care Unit Patients

Background: To investigate the risk factors for enterococcal intra-abdominal infections (EIAIs) and the association between EIAIs and outcomes in intensive care unit (ICU) patients. Methods: We reviewed retrospectively the records of patients with intra-abdominal infections admitted to the Department of Critical Care Medicine at Nanfang Hospital, Southern Medical University, China, from January 2011 to December 2018. Patients with intra-abdominal infections were divided into enterococcal and non-enterococcal groups based on whether enterococci were isolated from intra-abdominal specimens. Results: A total of 431 patients with intra-abdominal infections were included, of whom 119 were infected with enterococci and 312 were infected with non-enterococci. Enterococci were isolated in 27.6% of patients, accounting for 24.5% (129/527) of all clinical bacterial isolates. Post-operative abdominal infection (adjusted odds ratio [OR], 2.361; p = 0.004), intestinal infection (adjusted OR, 2.703; p < 0.001), Mannheim Peritonitis Index score (MPI; adjusted OR, 1.052; p = 0.015), and use of antibiotic agents within the previous 90 days (adjusted OR, 1.880; p = 0.025) were associated with an increased risk of EIAIs. Compared with patients without enterococcal infection, ICU patients with enterococcal infection had a higher risk of failure of initial clinical therapy (49.6% vs. 24.2%; p < 0.001) and longer hospital stays (33 days [19, 48] vs. 18 days [12, 29]; p < 0.001). Enterococcal infection was associated with increased 28-day mortality, in-hospital mortality, and ICU mortality. However, no difference was found in length of ICU stay between the two groups. Additionally, there was no difference in ICU mortality, hospital mortality, or 28-day mortality in patients infected with enterococcus who did or did not receive empirical anti-enterococcal therapy. Conclusion: Post-operative abdominal infection, intestinal infection, MPI score, and use of antibiotic agents within the previous 90 days were independent risk factors for enterococcal infection. Enterococcal infection was associated with reduced short-term survival in ICU patients.

Clinical study and management of acute peritonitis in Teritary care center

Background: Acute peritonitis is one of the most common surgical emergencies we encountered in day today practise. Though the diagnosis of peritonitis is easy but finding thhe underline cause is the diagnostic challenge to every surgeons. This requires a thorough clinical evaluation and specific investigations to have an accurate diagnosis. The management of acute peritonitis is a surgical challenge with high morbidity and mortality. Therefore it is necessary to study and evaluate various factors to understand the underlying cause to reduce the morbidity and mortality.AIM: Analysis of various causes of acute peritonitis with respect to morbidity and mortality and to assess Mannheim peritonitis index scoring system as a predictor of prognosis in acute peritonitis.Materials and Methods: It is a prospective study of patients above 18 years of age, who presented with acute peritonitis during the period of August 2020 to Jan 2021 were admitted under the dept of general surgery in Sree mookambika institute of medical sciences, kulashekaram. Results: Out of 52 patients included in this study, each patients were evaluated seperately and each one is subjected to mannheim peritonitis index score. With the help of scoring system, outcome of the patients were predicted earlier and managed accordingly. In my study population, age group between 41-50 is found to be on higher side with 18 patients (34%) followed by 51-60 years with 15 patients (28.84%). Male gender is more predominant in this study group with 36 patients (69.23%) where female gender on lower scale with 16 patients (30.76%). On assessing the date of persentation, 27 patients of the study population presented to our emergency department with in the first day with 51.9%. Each patients were subjected to earlier investigation and cause of the peritonitis were identified, among the causes of peritonitis, acute intestinal obstruction were found be on higher side in study population with 14 patients (26.92 %) followed by appendicular perforation with 11 patients( 21.15%). 20 patients (38.46%) were presented with signs of shock where remaining 32 patients(61.51%) show no sign of shock. In this study group, patients with Mannheim peritonitis index score less than 26 were noted in 36 patients (69.23%) and score more than 26 in 16 patients (31.73%). During my study, mortality was noted in only one patients with 1.9%. Conclusion: Mannheim peritonitis index score is found to be a useful stool in assessing the morbidity pre operatively. Patients with score less than 26 were found to have better prognosis with less hospital stay as well as post-operative complications while comparing the patients with score more than 26 were confirmed during my study. Score more than 26 were found to have lot of complications like burst abdomen, wound infection, prolonged hospital stay with significant mortality and morbidity.

Primary abdomen closure (using sheath relaxation) versus staged closure (using modified Bogota) following laparotomy in secondary peritonitis: a comparative study

Background: Primary closure or open laparostomy after laparotomy for peritonitis have their own morbidities. In this study, rectus sheath relaxation was used as an alternative to conventional primary closure and compared to the modified Bogota technique in patients of peritonitis.Methods: We included 60 patients of peritonitis with two of the following criteria: APACHE II score 10-20, Mannheim peritonitis index (MPI) 20-30 or post-resuscitation intraabdominal pressure (IAP) &gt;15 mmHg and randomized them to group A (Sheath relaxation technique) and group B (modified Bogota). Outcome criteria studied included procedure failure, complications, pain, mortality and duration of ICU and hospital stay.Results: Both groups were comparable in terms of age, gender, inclusion criteria, ICU stay and mortality. The success rate in group A was 63.33% while in group B, was 53.33% with complication rates of 37% and 46.67% respectively. The pain and duration of hospital stay were significantly less in group A.Conclusions: We concluded that primary abdomen closure using rectus sheath relaxation in select patients was an easy, feasible and better alternative than the staged closure using modified Bogota technique following laparotomy in patients of severe secondary peritonitis. Patients with higher APACHE II and MPI scores may be better managed primarily by modified Bogota technique, while those with lower APACHE II and MPI do well with primary closure with sheath relaxation. The pre- operative APACHE II, MPI and post resuscitation IAP either individually or in combination, could, therefore, predict the wound failure rates, choice of closure techniques.

How emergency surgery has changed during the COVID-19 pandemic: A cohort study

IntroductionVarious surgical societies constantly update their recommendations in order to adapt surgical activity on current Pandemic conditions. The aim of this study is to analyze how hospitalizations and emergency operations have changed in our Department of Medical and Surgical Sciences in the Hospital of Foggia during covid-19 pandemic. MethodsOur cohort-study was conducted by analyzing two groups of patients admitted to the Department of Medical and Surgical Sciences of the Hospital of Foggia: those admitted during the no-covid period from March 09th, 2019 to May 09th, 2019 and those during the covid period from March 09th, 2020 to May 09th, 2020. ResultsA total of 750 patients admitted during the no-covid period of 2019 and 171 during the covid period of 2020, of these 222 were emergency admission during 2019 and 97 during 2020, 528 were elective admission during 2019 and 74 during 2020. Of the emergency admissions (222 during 2019 and 97 during 2020), 91 were operated during the no covid period in 2019 and 52 during the covid period in 2020. The mean Mannheim Peritonitis Index Score, that is a scoring system used in peritonitis which is simple and cost-effective, were 15.6 during the no covid period of 2019 and 22.2 during the covid period of 2020. We observed 29 post-operative complications during 2019 and 26 during 2020. ConclusionsContraction of admissions for urgent and emergent conditions in the first period of lockdown has been followed from some positive effects as well as aggravating consequences.

A prospective study of effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group &lt;50 years and 46% patients were in the age group &gt;50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was &gt;24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was &lt;21 while 25 (25%) patients total score was 21-29 and it was &gt;29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.

The Quick Sequential Organ Failure Assessment (qSOFA) Score is a Poor Mortality Predictor in Patients with Complicated Intra-abdominal Infections

BACKGROUND: Despite the evolution in surgical treatment and antimicrobial therapy in the last years the complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality. Different scoring systems are already available for early prognostic evaluation and yet none has been widely accepted.&#x0D; AIM: Our aim was to evaluate the prognostic accuracy of quick sequential organ failure assessment (qSOFA), one of the most recent scores, in patients with cIAIs.&#x0D; MATERIALS AND METHODS: We studied retrospectively 110 patients with cIAIs admitted to the Department of Surgical Diseases (DSD) at University Hospital “Prof. Dr. Stoyan Kirkovich” Stara Zagora from January 2017 to July 2019. Area under receiver operating characteristics (AUROC) curves of systemic inflammatory response syndrome (SIRS), qSOFA, and Mannheim Peritonitis Index (MPI) were analyzed and a comparison of ROC curves was performed to explore their prognostic performance.&#x0D; RESULTS: Twenty-five (22.7%) patients died during hospitalization. qSOFA score showed poor prognostic accuracy (AUROC = 0.698, 95% CI = 0.566–0.829), worse than MPI score (AUROC = 0.698 vs. 0.844), but better than SIRS (AUROC = 0.698 vs. 0.583). The qSOFA score ≥2 points was observed with lack of sensitivity (32.0%) as outcome predictor. ROC curve analysis showed prognostic inferiority of qSOFA compared to MPI (difference between areas = 0.146, p = 0.0232).&#x0D; CONCLUSION: In patients with cIAIs, quick-SOFA score was observed with poor prognostic performance.

Evaluation of Mannheim peritonitis index to predict outcome of patients with hollow viscus perforation

Background: Acute generalized peritonitis from gastrointestinal hollow viscus perforation is a potentially life-threatening condition. Mannheim peritonitis index (MPI) is a specific scoring system that facilitates early identification of patients with severe peritonitis for aggressive surgical approach and improved outcomes.Methods: A prospective observational study in 60 patients attending surgical emergency unit with perforation peritonitis was conducted to analyse the predictive capacity of MPI. MPI score was categorized into 3 groups: &lt;21, 21 to 29 and &gt;29. Data was compared for predicting mortality and morbidity. P value, chi square test and 95% CI were used as statistical tools.Results: Two thirds of 60 patients studied were younger than 50 years of age. Prognosis was poorer in patients above 50 years with age. 80% presented after 24 hours. Ileal perforation was the commonest etiology. Morbidity and mortality were worst in patients with MPI score &gt;29.Conclusions: Mannheim peritonitis index is disease specific, easy to apply and effective scoring system predicting the outcome in perforation peritonitis, with increasing MPI score being directly proportional to higher mortality and morbidity of the patient.

Mortality rate in patients with Secondary Peritonitis in Ain Shams University Hospitals as regard Mannheim Peritonitis Index (MPI) score

Abstract Introduction Secondary peritonitis is one of the most common fatal surgical emergencies. The mortality rate is about 20% even in well- equipped places. The outcome can be improved be rapid surgical intervention and intensive care of the patient. Many scoring systems were developed to identify high-risk patients who may need rapid intervention or intensive care. Mannheim Peritonitis Index (MPI) is an easy and specific score for predicting the outcome of secondary peritonitis. Patients and Method It’s an observational prospective study over 50 patients presented with secondary peritonitis to our E.R during the period from January 2018 to June 2018 and patients were followed up for one month. Patients were divided into three groups according to their MPI score, Group I: with MPI score less than 21, Group II: with MPI score between 21 and 29, and Group III: with MPI score more than 29. Results In the present study, Mortality rate was about 24%. Mortality rates in those groups were 0%, 5.5% and 55% respectively which are similar to results of other studies performed in other places. Cut-off value is 28 with sensitivity 91% and specificity 76%. Conclusion MPI score is effective in predicting outcome of patients with secondary peritonitis in our hospitals.

Evaluation of Usefulness of Mannheim Peritonitis Index and APACHE II Score in Predicting Mortality and Morbidity in Patients with Peritonitis- A Prospective Diagnostic Test Study

Introduction: Peritonitis, defined as inflammation of the peritoneal cavity can be of various causes, and is one of the most common surgical emergencies. This continues to be a challenge to diagnose and treat. Early intervention is essential to select patients who will need intensive care which brings out better outcome for the patients. This also helps us use the resources optimally. Over years, many scoring systems have been developed and studied to predict outcomes in patients with peritonitis. Aim: To evaluate the ability of Mannheim Peritonitis Index (MPI) and APACHE II (Acute Physiology And Chronic Health Evaluation II) scores in predicting mortality and morbidity in patients with peritonitis. Materials and Methods: A prospective, observational study was conducted at Christian Medical College and Hospital, Vellore, Tamil Nadu, India, for a period of two years from September 2014 to August 2016. A total of 78 patients were recruited for this study. These patients were scored with MPI and APACHE II scores. The primary outcome studied was in hospital death or discharge. The secondary outcome studied was morbidity in terms of local and systemic complications. The risk factors associated with mortality in patients with peritonitis were also studied. The best cut-off value for MPI and APACHE II from the data was calculated using Yuden index. The sensitivity, specificity and likelihood ratios were calculated and presented with 95% Confidence Interval(CI). The sub-group analysis was done for risk factors and complications. Results: There were more males than females. Age ≥48 years (p=0.002) and serum creatinine ≥1.3 g/dL (p=0.012) were found to be significant risk factors for mortality. The sensitivity and specificity of MPI ≥27 in predicting mortality was found to be 90% and 57% respectively. The sensitivity and specificity of APACHE II score ≥10 in predicting mortality was found to be 40% and 78%, respectively. MPI scores ≥27 were strongly associated with morbidity like prolonged ICU stay (p=0.004), mechanical ventilation requirement (p=0.001) and need for dialysis (p=0.035). Conclusion: Present study showed MPI to be a better predictor of mortality than APACHE II, though APACHE II showed better specificity. MPI score also was helpful in predicting morbidity such as prolonged ICU stay, mechanical ventilation requirement postoperatively and need for dialysis postoperatively. MPI was easier to use as it contained lesser variables. MPI could be of use in rural areas with no facility for laboratory investigations and blood gas analysis.