Peritonitis Index Research Articles

Perforated gastroduodenal ulcers: perioperative prognosis and prevention of complications

Objective. To improve the effectiveness of treatment for patients with perforated gastroduodenal ulcers (PGDU) by developing criteria for predicting postoperative complications and mortality. Materials and methods. The treatment outcomes of 127 patients with PGDU were analyzed. Prognostic scales ASA, SOFA, Peptic Ulcer Perforation Score (PULP), and the Mannheim Peritonitis Index (MPI) were used for the assessment in all the patients. Specialized classifications (DEP and ulcer defect classes) developed at Sklifosovsky Research Institute For Emergency Medicine were employed to determine the surgical approach and the extent of surgical intervention. Results. Duodenal ulcers were observed in 97(76.4 %) patients, gastric ulcers in 28(22.0 %), and combined ulcers in 2(1.6 %). According to the clinical form, chronic ulcers were identified in 81 (63.8 %) patients, while acute ones were detected in 46(36.2 %) patients. Helicobacter pylori infection was revealed in all patients with chronic ulcers. The majority of patients sought medical care within the first 6 hours after perforation (53 patients, 41.7 %); from 6 to 12 hours – 24 patients (18.9 %), 12–24 hours – 17 patients (13.4 %), and in more than 24 hours – 33 patients (26.0 %). Fatal outcome occurred in 45 (35.4 %) patients, while 82 (64.4 %) patients were discharged after the recovery had been observed. The mortality rate was significantly higher in patients with MPI grades 2 and 3, in those with an initially high risk according to the PULP scale, and those who were hospitalized more than 24 hours after perforation. Indications for laparoscopic ulcer suturing were proposed based on the scales used. Conclusions. The risk factors for adverse outcomes in PGDU include the following criteria: surgery performed more than 24 hours after perforation, MPI 2-3 grades, and a PULP scale score more than 8. In patients with PGDU who are at high surgical-anesthetic risk and have a complicated comorbid background, the risk of sepsis development is more than 30 %. Laparoscopic techniques for suturing PGDU are preferable when performed within 6 hours of perforation, with a PULP score not more than 7, MPI grade 1, and DEP classification scores less than 9, specifically in IIC, IIIC, IVA, IVB, and IVC ulcer defect classes.

Open abdomen versus primary closure in nontrauma patients: A weighted analysis of a single-center experience

INTRODUCTION The open abdomen (OA) technique is nowadays a worldwide strategy both for trauma and emergency general surgery. Despite the attempt at conducting prospective studies, a high level of evidence is far from established. The aim of this study was to investigate if we overused this strategy and if it improved the postoperative course of our patients. METHODS Emergency laparotomies from 2017 and 2023 were reviewed and stratified according to OA and closed abdomen (CA). Differences were balanced by inverse probability weighting, and the 90-day mortality was estimated. Subgroup analysis was carried out for patients with a Mannheim Peritonitis Index (MPI) of >26, bowel obstruction, bowel ischemia (BI) and gastrointestinal perforation. RESULTS Of the 320 patients, 167 were CA and 153 were OA. Groups were different for American Society of Anesthesiologists, comorbidities, transfusion rate, Physiologic and Operative Severity Score for the Study of Mortality and Morbidity score, MPI, Clinical Frailty Scale score, diagnosis, and resection. Two balanced pseudo-populations were created. The 90-day survival rate was 50.8% for CA and 60.8% for OA (hazard ratio [HR], 0.79; confidence interval [CI], 0.40–1.55; p = 0.502). At the Cox regression, the Clinical Frailty Scale score (HR, 1.125; 95% CI, 1.01–1.25; p = 0.033) and BI (HR, 5.531; 95% CI, 2.37–12.89; p < 0.001) were independent risk factors for mortality. Transfusion rate (odds ratio [OR], 3.44; 95% CI, 1.44–8.23; p < 0.006) and length of stay in the intensive care unit (OR, 1.13; 95% CI, 1.07–1.20; p < 0.001) were associated with major complications. Open abdomen did not modify mortality in the case of bowel obstruction, MPI >26, or gastrointestinal perforation. Finally, OA (HR, 0.056; 95% CI, 0.01–0.22; p = 0.001) and large bowel resection (HR, 6.442; 95% CI, 1.28–32.31; p = 0.040) were predictors of longer survival in the subgroup of patients with BI. CONCLUSION Open abdomen was not associated with a higher complication rate or higher mortality but did result in a longer in-hospital stay. The only setting where OA seemed to be advantageous was in the BI population. LEVEL OF EVIDENCE Epidemiological and Prognostic Study; Level III.

A Descriptive Study on the Evaluation Mannheim Peritonitis Index to Predict the Outcome of Patients with Peritonitis

A Descriptive Study on the Evaluation Mannheim Peritonitis Index to Predict the Outcome of Patients with Peritonitis

Early Operative Risk Assessment Using the Modified Mannheim Peritonitis Index in Patients With Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria.

Introduction The use of validated prognostic scoring tools in resource-poor environments has been hampered by the cost of procuring and maintaining devices, such as arterial blood gas analysers, to measure critical physiological derangements.Attempts need to be made to adapt these applicable risk stratification tools so they can be easily adopted in developing countries like Nigeria. Aim This study assessed the usefulness of a modified Mannheim peritonitis index (mMPI) as arisk stratification tool in predicting surgical outcomes in managing patients with generalised peritonitis in Abuja, Nigeria. Methods This was a prospective study of consecutive adult patients managed for generalised peritonitis at a tertiary hospital in Abuja over 12 months. Approval numbers NHA/EC/037/2019 and AF/013/17/110/1514 were ascribed to the project by the Institute Review Board Committee (IBR) of the National Hospital Abuja (NHA) and the National Postgraduate Medical College of Nigeria. The MPI was modified using respiratory rate and suboptimal percentage oxygen saturation (SpO2). Patient characteristics and treatment outcomes obtained were entered into a structured proforma, checked, and analysed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The threshold score of the modified MPI and the accuracy, sensitivity, and specificity were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. The level of statistical significance was set at a p-value of <0.05. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (n=15, 30.6%), followed by complicated appendicitis (n=12, 24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predicts mortality at a threshold score point of ≥26 (accuracy of 79.4%, sensitivity of 85.7%, specificity of 61.9%, p=0.013) and morbidity at a threshold score of ≥23 (accuracy of 78.4%, sensitivity of 77.4%, specificity of 72.2%, p=0.001). Conclusion The modified MPI can be used as a risk assessment tool to predict postoperative outcomes in adult patients operated on for generalised peritonitis within 30 days of operative intervention at Abuja.This modification may be helpful in low-resource centres with limited access to arterial blood gas analysers. However, the original MPI might be a more accurate tool.

Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index.

This study aimed to analyze the prognostic value of the SOFA, APACHE II, and MPI (Mannheim Peritonitis Index) scores in the indication for Damage Control Surgery (DCS) in non-trauma. Retrospective analysis of patients undergoing DCS between 2014 and 2019. SOFA and APACHE II scores were calculated using parameters preceding DCS, while MPI was based on surgical descriptions. Statistical analysis: Qualitative variables were compared using the Chi-square test or Fisher's exact test, and quantitative variables using Pearson's correlation coefficient. The Student's T test was employed for mean comparisons. The sample comprised 104 patients (59 males), with a median age of 63.5years, of whom 52 (50%) were ASA IV. Operative findings leading to DCS included peritonitis (54; 51.9%), intestinal ischemia (39; 37.5%), inability to close the abdomen (8; 7.6%), and bleeding (3; 2.9%). The mortality rate was 75% (78/104). Thirty patients (28.8%) died after DCS; the remainder underwent one (35; 33.6%), two (21; 20.2%); three (8; 7.7%), and four or more (10;9.7%) revision procedures. The median lengths of ICU and hospital stays were 12.5 and 20.5days, respectively. The median score values were as follows: SOFA: 12 (0-38), APACHE II: 25 (2-47), and MPI: 26 (8-43). Besides ASA classification (p = 0.03), mortality risk was influenced by: age (≤ 65years vs. > 65years; p = 0.04), SOFA (≤ 10 vs. > 10; p = 0.03), APACHE II (≤ 25 vs. > 25; p = 0.04), and MPI (≤ 25 vs. > 25; p = 0.003). The SOFA, APACHE II, and MPI scores proved to be valuable tools in the prognostic assessment of patients undergoing DCS in non-traumatic abdominal emergencies.

FP7.18 - Early Operative Risk Assessment Using Modified Mannheim Peritonitis Index in Patients with Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria

Abstract Aim This study assessed the usefulness of a modified Mannheim Peritonitis Index (MPI) as a risk stratification tool in predicting surgical outcomes in the management of patients with generalized peritonitis in Abuja, Nigeria. Methods This is a prospective study of consecutive adult patients managed for generalized peritonitis at a tertiary hospital in Abuja Nigeria within a one-year duration. The MPI was modified using respiratory rate and SpO2. Patient characteristics and outcome of treatment obtained were entered into a structured proforma, checked and analysed using the SPSS, version 25. The threshold score of the modified MPI, as well as the accuracy, sensitivity, and specificity, were derived from the receiver-operator characteristic (ROC) curve analysis and its coordinates. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (30.6%) followed by complicated appendicitis (24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predict mortality at a threshold score point of ≥26 (Accuracy of 79.4%, sensitivity of 85.7% specificity of 61.9%, P-value = 0.013), and morbidity at a threshold score of ≥23 (Accuracy 78.4%, sensitivity of 77.4%, specificity of 72.2%, P-value = 0.001). Conclusion The modified MPI can be used as a risk assessment tool in predicting postoperative outcomes in adult patients operated for generalised peritonitis within 30 days of operative intervention at Abuja. This modification can be useful in low-resource centres with limited access to arterial blood gas analysers.

Efficacy of the Mannheim Peritonitis Index in Predicting the Prognosis of Small Intestinal Perforation: A Retrospective Study

Efficacy of the Mannheim Peritonitis Index in Predicting the Prognosis of Small Intestinal Perforation: A Retrospective Study

Effectiveness of Mannheim's Peritonitis Index in Patients With Peritonitis Secondary to Hollow Viscus Perforation in a Tertiary Care Hospital in Jharkhand, India.

Introduction Peritonitis refers to the inflammation of the peritoneum and peritoneal cavity. Causes of peritonitis can be bacterial (gastrointestinal or non-gastrointestinal), chemical, traumatic, or ischemic. Peritonitis can be localized or diffuse, acute or chronic. Peritonitis can be primary, secondary, or tertiary, according to the pathogenesis. Peritonitis developed secondary to hollow viscus perforation is a life-threatening condition and a common cause of emergency surgery in India. The Mannheim peritonitis index (MPI) is a simple scoring system that can accurately predict the outcome of peritonitis.This study aimed to evaluate the effectiveness of MPI in predicting mortality risk or prognosis in patients with peritonitis due to hollow viscus perforation. Materials and methods This observational cross-sectional study at the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, involved 111 patients with peritonitis due to hollow viscus perforation from December 2021 to March 2022. Detailed history, clinical examination, relevant blood tests, and radiological investigations established a diagnosis of perforation peritonitis, followed by a score assessment. Data were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). Results Patients >50 years had higher mortality (i.e., 18/43) than patients <50 years (i.e., 13/68). Overall mortality was 31, which included one in low risk, 12 in intermediate risk, and 18 in the high-risk group. Mortality was lowest in the low-risk group (i.e., 1/30), highest in the high-risk group (i.e., 18/40), and 12/41 in the intermediate-risk group; the p-value was <0.05, which was highly significant. Mortality was higher in patients presenting after 24 hours, having organ failure, and non-colonic sepsis. Conclusion The MPI scoring system is simple, easy to calculate, cost-effective, precise, and effective in assessing mortality and morbidity risk in patients with peritonitis due to hollow viscus perforation. It can also guide further management strategies.

Comparison of Accuracy between Mannheim Peritonitis Index and Jabalpur Score in Predicting the Mortality in Perforative Peritonitis Patients Presenting for Emergency Surgery at a Tertiary Care Setup of Eastern India

Abstract Background and Objective: Peritonitis following hollow viscus perforation is commonly encountered in surgical emergency, which needs prompt and aggressive management. Unlike foreign nations, no score is routinely used in most tertiary medical colleges of India for prognostication of these patients preoperatively, leading to delay in adequate management and poor outcome. The aim of this research is to compare the accuracy of Mannheim peritonitis index (MPI) and Jabalpur score in prediction of mortality of patients presenting with perforative peritonitis. Materials and Methods: Fifty-one patients presenting with perforative peritonitis between November 2022 and April 2024 were scored using the two scoring systems and patients followed up over 30 days. Mortality based on scores of the scoring systems was analyzed. Results: Both scores had a significant P value, suggesting that both are efficient scoring systems. Receiver operating characteristic curves for both scores were plotted, and the area under the curve was calculated. Chi-square test showed no significant difference between the two scoring systems. Conclusion: Jabalpur score and MPI are both efficient scoring systems. Utilization of either of the scoring systems depends on the availability of resources in the health-care setup.

Staphylococcus lugdunensis Peritoneal Dialysis-Related Peritonitis: A Matched Comparative Analysis

Staphylococcus lugdunensis (S lugdunensis) is a coagulase-negative staphylococcus species that has been increasingly recognized to cause serious infections with virulence resembling Staphylococcus aureus (S aureus). No studies have evaluated the characteristics and outcomes of patients with S lugdunensis peritoneal dialysis-related peritonitis compared with those with S aureus peritonitis. We aim to evaluate the clinical course of peritonitis as caused by these organisms. A retrospective matched comparative analysis involving a single tertiary center from July 2000 to July2020. Forty-eight episodes of S aureus peritonitis were matched to 19 cases of S lugdunensis peritonitis. The cases were individually matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3). A comparative analysis was performed between the 2 organisms. The outcome includes responses at day 5 of peritonitis and the rate of complete response. There is a higher predilection of diabetes in those with S aureus peritonitis than in those with S lugdunensis (64.6% vs 31.6%; P=0.03). Patients with S aureus peritonitis also have a much higher total cell count at presentation (4,463.9±5,479.5 vs 1,807.9±3,322.7; P=0.05); a higher prevalence of poor response at day 5 (50.0% vs 15.8%; P=0.03); a lower rate of complete response (64.6% vs 94.7%; P=0.01) and are more prone to relapse with the same organism (29.2% vs 0%, respectively; P=0.01) as compared to those with S lugdunensis. The result of this small retrospective study involving a single center may not be generalizable to other centers. There is also no data for comparative analysis on other coagulase-negative staphylococci such as Staphylococcus epidermidis, which belongs to the same family as S lugdunensis. Although S aureus peritonitis is more virulent with significant morbidity, S lugdunensis can cause similarly serious peritonitis. This largest case series of S lugdunensis peritonitis enabled better characterization of clinical features and outcomes of patients with S lugdunensis peritonitis.

ПРОГНОЗИРОВАНИЕ ПЕРСИСТИРУЮЩЕГО ПЕРИТОНИТА В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

Objective: Improve the treatment results of patients with diffuse peritonitis by accurately predicting the progression of persistent peritonitis to septic shock in the postoperative period Methods: The study involved 75 patients with diffuse peritonitis. These patients were split into two groups based on whether their peritonitis persisted after surgery and if they needed further surgery. The study used pre- and intraoperative clinical and laboratory predictors to determine the progression of peritonitis to septic shock Results: The preoperative CT attenuation coefficient of intraperitoneal fluid, measured in Hounsfield units (HU), was significantly higher in the study group compared to the control group (28.35 HU vs. 18.3 HU; p&lt;0.001). The scores on the Mannheim Peritonitis Index (MPI) were also significantly higher in the study group compared to the control group (25 versus 16; p&lt;0.001). Additionally, the levels of presepsin (PSEP), procalcitonin (PCT), and C-reactive protein (CRP) were higher in the study group compared to the control group (p&lt;0.001): 1149.1 (153.7-2591) pg/ml, 12.7815 (4.286-22.557) ng/ml, and 232.5 (162.2-312.4) mg/l in the study group, and 410.3 (56.1-980.9) pg/ml, 3.087 (0.995-13.399) ng/ml, and 120.8 (25.7-280) mg/l in the control group, respectively Conclusion: The proposed method for predicting the progression of peritonitis to septic shock is based on the MPI score and the CT attenuation coefficient of intraperitoneal fluid, in combination with biomarkers of inflammation such as PSEP, PCT, and CRP. This method allows practical surgeons to recognize persistent peritonitis, be prepared for the deterioration of a patient's condition with the progression of persistent peritonitis to septic shock, and perform a timely and appropriate surgical intervention Keywords: Persistent peritonitis, tertiary peritonitis, Hounsfield unit, inflammatory markers.

Prediction of mortality in secondary peritonitis: a prospective study comparing p-POSSUM, Mannheim Peritonitis Index, and Jabalpur Peritonitis Index

BackgroundRisk scoring systems are required to allow accurate prognostication, compare outcomes of surgery, and allow patients to make informed decisions about their health. This prospective study compares the p-POSSUM (Portsmouth Modification to Physiological and Operative Severity Score for Enumeration of Mortality), Mannheim Peritonitis Index, and Jabalpur Peritonitis Index for their utility in predicting mortality in patients with peritonitis.MethodsPerioperative data was collected from 235 patients with secondary peritonitis and used to calculate p-POSSUM, MPI, and JPI scores. The accuracy of the 3 scores was compared using receiver operator characteristic curves.Resultsp-POSSUM and Mannheim Peritonitis Index were similar in their accuracy with area under the curve (AUC) values of 0.756 and 0.757. Jabalpur Peritonitis Index had an AUC of 0.665.Conclusionp-POSSUM and Mannheim Peritonitis Index can be used to predict mortality in patients with secondary peritonitis. Jabalpur Peritonitis Index is not suited for this purpose. Further studies are required to improve the diagnostic performance of p-POSSUM and MPI in patients with secondary peritonitis.

A comparative analytical study on outcome of secondary peritonitis using Mannheim's peritonitis index in geographically diverse Indian patients.

Secondary peritonitis is caused by infection of the peritoneal cavity due to perforation of the alimentary tract. Mannheim's peritonitis ındex (MPI) is a prognostic scoring system that predicts outcomes in peritonitis. Increasing MPI scores correlate with poor outcomes and mortality. The objective of this study is to evaluate the effectiveness of MPI-based prognosis and its impact on Indian patients with secondary peritonitis. For understanding the effectiveness of the MPI scoring system, a cross-sectional data analysis of published studies on secondary peritonitis from 10 geographical locations in India was performed. The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population. Patients were divided into risk groups on the basis of MPI scores: <21 mild, MPI= 21-29 moderate, MPI> 29 severe risk. We observed a significant correlation between mortality with age and gender as reported worldwide. Site of perforations were prevalent in the upper alimentary tract with the majority being gastro-duodenal for the Indian population as opposed to distal parts in the western population. Higher lethality in India is often associated with evolution time, organ failure, and sepsis due to delayed presentation and poor management. MPI scoring is effective in predicting risk across geographically diverse Indian populations. The sensitivity and specificity of MPI scores are more reliable and a score >29 specifically recommends aggressive resuscitation & monitoring of patients, initiation of broad-spectrum antibiotics, and intensive care support to reduce mortality and morbidity.

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.

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial.Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis.Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups.Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome.Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

Utility of Mannheim’s Peritonitis Index in Predicting Outcome of Peritonitis in Patients with Hollow Viscous Perforation

INTRODUCTION Peritonitis due to hollow viscous perforation is one of the common causes for emergency surgery requiring immediate surgical intervention. Scoring systems that provide objective descriptions of the patient’s conditions at specific points in the disease process aid our understanding of these problems. Hence this study is undertaken to study the effectiveness of Mannheim’s peritonitis index in predicting the outcome in peritonitis patient. MATERIAL AND METHODS This study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of 44 patients with diagnosis of peritonitis due to hollow viscous perforation over period 2 years was included in this study. History and detailed clinical examination were performed as per the working proforma. Blood investigation was done. Data analysis was done using SPSS (Statistical Package for social sciences) version 25. RESULTS In this study 44 cases of peritonitis due to hollow viscous perforation were included. The mean age of patients was 38.16 ± 21.09 years. Abdominal pain and abdominal distension were most common presentation. MPI scoring system done in all patients depending on preoperative and intra-operative and patients were categorized into three categories, &lt;21, 21 to 29, and &gt;29 where 50% of patients had MPI less than 21, 25% of patient had MPI score 21-29 and 25% of patient had MPI score &gt;29. CONCLUSION MPI scoring system is required to predict the outcome in peritonitis patients and whether the line of management taken is appro- priate or needs to be changed.

Effectiveness of Mannheim Peritonitis index in Predicting the Morbidity and Mortality of Patients with Hollow Viscous Perforation

Effectiveness of Mannheim Peritonitis index in Predicting the Morbidity and Mortality of Patients with Hollow Viscous Perforation

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.