Peritonitis Index Research Articles

A clinical study to predict the outcome of patients with hollow viscus perforation in a tertiary care hospital using manheim peritonitis index

Introduction: Since a longtime multiple effort are been put forwarded to design an effective scoring system as to predict the outcome as to mortality and morbidity of patients admitting to hospitals with hollow viscus perforations. Of number of proposed systems Mannheim Peritonitis index is quite simple and effective scoring system proposed to predict the outcome of the patients admitted to hospital with hollow viscus perforations. Objective: To assess the validity of Mannheim Peritonitis Index (MPI) for predicting the surgical outcome, mortality and morbidity of cases presenting with Hollow viscus perforation. Method: Current prospective study was one over a period of three years form 2014-2017 at Department of Surgery, Government Medical College, Anantapuramu and included 100 cases between 17-46 years of age. Results: The results of the current study indicated that duodenal perforations are common amongst the hollow viscus perforations, clear exudates were common among peritonitis cases. about 50% of cases presented with postoperative complications. Subjects fitting into MPI scores between 22-29 presented with surgical site infections. higher MPI scores are associated to higher ICU stays. Higher score are observed in cases with feculent and purulent exudates and in turn to relatively more number of complications. Conclusion: The Mannheim Peritonitis index provide a novel and excellent platform as to predict the surgical outcome, mortality and morbidity in cases of hallow viscera perforations with peritonitis with all associated issues related to the conditions.

Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria

BackgroundSevere complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database.MethodsAll consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality.ResultsPredictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality).ConclusionsNo one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest “inclusion-criteria” to recognize patients with a high chance of mortality and ICU admission.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03163095; Registered on May 22, 2017.

A prospective study of Mannheim peritonitis index as a prognostic scale in analysis of outcome in hollow viscus perforation

Background: MPI as a prognostic index helps in analysis of prognosis in peritonitis in hollow viscus perforation. The factors that are considered in MPI index are routinely used in assessment of surgical patients, they are easily available, routinely performed, and helps in arrival at a prognosis in fast and effective way.Methods: A prospective survey of patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards of our institute during the period starting from January 2014 to December 2015. Study population consisted of 150 consecutive patients with performative peritonitis, which confirmed on emergency laparotomy.Results: The Mannheim peritonitis index emerged as a reliable marker for assessing the severity and prognosis of intra-abdominal infection with sensitivity and specificity comparable to APACHE II score which has been adopted as the gold standard by Surgical Infection Society. The score designed specifically for peritonitis, combines preoperative and operative data and is easy to apply. MPI scores were consistent with low scores among survivors and higher scores among non-survivors.Conclusions: MPI scores in the analysis were sharp predictor of mortality.

Damage control surgery in perforated diverticulitis: ongoing peritonitis at second surgery predicts a worse outcome.

Damage control strategy (DCS) is a two-staged procedure for the treatment of perforated diverticular disease complicated by generalized peritonitis. The aim of this retrospective multicenter cohort study was to evaluate the prognostic impact of an ongoing peritonitis at the time of second surgery. Consecutive patients who underwent DCS for perforated diverticular disease of the sigmoid colon with generalized peritonitis at four surgical centers were included. Damage control strategy is a two-stage emergency procedure: limited resection of the diseased colonic segment, closure of oral and aboral colon, and application of a negative pressure assisted abdominal closure system at the initial surgery followed by second laparotomy 48h later. Therein, decision for definite reconstruction (anastomosis or Hartmann's procedure (HP)) is made. An ongoing peritonitis at second surgery was defined as presence of visible fibrinous, purulent, or fecal peritoneal fluid. Microbiologic findings from peritoneal smear at first surgery were collected and analyzed. Between 5/2011 and 7/2017, 74 patients underwent a DCS for perforated diverticular disease complicated by generalized peritonitis (female: 40, male: 34). At second surgery, 55% presented with ongoing peritonitis (OP). Patients with OP had higher rate of organ failure (32 vs. 9%, p= 0.024), higher Mannheim Peritonitis Index (25.2 vs. 18.9; p= 0.001), and increased operation time (105 vs. 84min., p= 0.008) at first surgery. An anastomosis was constructed in all patients with no OP (nOP) at second surgery as opposed to 71% in the OP group (p< 0.001). Complication rate (44 vs. 24%, p= 0.092), mortality (12 vs. 0%, p= 0.061), overall number of surgeries (3.4 vs. 2.4, p= 0.017), enterostomy rate (76 vs. 36%, p= 0.001), and length of hospital stay (25 vs. 18.8days, p= 0.03) were all increased in OP group. OP at second surgery occurred significantly more often in patients with Enterococcus infection (81 vs. 44%, p= 0.005) and with fungal infection (100 vs. 49%, p= 0.007). In a multivariate analysis, Enterococcus infection was associated with increased morbidity (67 vs. 21%, p< 0.001), enterostomy rate (81 vs. 48%, p= 0.017), and anastomotic leakage (29 vs. 6%, p= 0.042), whereas fungal peritonitis was associated with an increased mortality (43 vs. 4%, p= 0.014). Ongoing peritonitis after DCS is a predictor of a worse outcome in patients with perforated diverticulitis. Enterococcal and fungal infections have a negative impact on occurrence of OP and overall outcome.

Reoperation After Laparoscopic Colorectal Surgery. Does the Laparoscopic Approach Have Any Advantages?

IntroductionThe laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. MethodsPatients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. ResultsA total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs 29.2%) and more colostomies in the OS group (37.5% vs 6.2%), P<.05. MPI was higher in OS group (27.31±6.47 [19–35] vs 18.36±7.16 [11–24], P<.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (P<.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (P<.05). ConclusionsA laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.

Mannheim Peritonitis Index (Mpi) Score as A Predictor of Outcome in Patients with Secondary Peritonitis

INTRODUCTION: Secondary bacterial peritonitis from hollow viscous perforation is one of the common surgical emergencies and carries higher mortality. Several scoring systems are applied to predict the outcome of patients with perforation peritonitis. Mannheim Peritonitis Index (MPI) is one among many. Our aim of the study is to evaluate Mannheim peritonitis Index for predicting the outcome in patient with secondary bacterial peritonitis. MATERIALS AND METHODS: A retrospective study was conducted in the Department of General Surgery, Universal College of Medical Sciences, Bhairahawa from February 2012 to July 2013. All patients clinically diagnosed as peritonitis and who underwent laparotomy were included in the study. MPI score of all the study patients were calculated and categorized into three groups depending upon the score; less than 15, 15-25 and more than 25. Mortality of patients from each group was calculated and predictive value of each factor was determined. RESULTS: Total 60 patients were included in the study. Forty-four were male and sixteen were female. There were total five mortalities. All were of above 50 years age group. Patients beyond 50 years of age had a significantly higher (p = .005) probability of dying in the early post-operative period. MPI score more than 15 was not statistically significant (p = .06), patients with MPI more than 25 had more probability of dying, hazard ratio (HR 3.4 with 95% CI).Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14, page: 6-9

To Predict the Prognosis in Patients with Perforative Peritonitis Using Mannheim Peritonitis Index and Multiple Organ Failure Score

To Predict the Prognosis in Patients with Perforative Peritonitis Using Mannheim Peritonitis Index and Multiple Organ Failure Score

Usefulness of Mannheim’s Peritonitis Index Screening System in Predicting Outcome in Patients with Peritonitis

Usefulness of Mannheim’s Peritonitis Index Screening System in Predicting Outcome in Patients with Peritonitis

Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico?

IntroductionThe laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. MethodsPatients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. ResultsA total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). ConclusionsA laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.

Risk factor analysis and strategy of intra-abdominal infection

Multiple factors can lead to treatment failure and death in the patients with intra-abdominal infection. These factors include advanced age, malignancy, significant cardiovascular compromise, significant liver and renal diseases, hypo-albuminemia, diffuse peritonitis, delayed initial source control, delayed and unexpected initial source control, and suspected infection with resistant pathogens. Scoring system such as Mannheim Peritonitis Index (MPI) and complicated intra-abdominal score can also help to evaluate the risk of intra-abdominal infection patients. Sepsis and septic shock are important risk factors. Treatment strategies include prompt resuscitation and organ function support, early appropriate source control measures, effective antibiotics coverage of pathogens, prevention and treatment of resistant bacterial. Key words: Intra-abdominal infection; Risk factors; Resuscitation; Source control

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Data from 112 patients presenting at our Training and Research Hospital Emergency Surgery Department between January 2010 and December 2015 who were diagnosed with PUP through physical examination and laboratory and radiological tests and operated at the hospital have been retrospectively analyzed. Patients were divided into three groups based on morbidity (Group 1), mortality (Group 2), and no complication (Group 3). Of the 112 patients included in the study, morbidity was observed in 21 (18.8%), mortality in 11 (9.8%), and no complication was observed in 80 (71.4%), who were discharged with cure. The differences between group for the average values of the perforation diameter and American Society of Anesthesiologists, Acute Physiology and Chronic Health Evaluation II, and Mannheim Peritonitis Index scores were statistically significant (p<0.001 for each). The average values for the group with mortality were significantly higher than those of the other groups. In this study where we investigated risk factors for increased morbidity and mortality in PUPs, there was statistically significant difference between the average values for age, body mass index, perforation diameter, and Acute Physiology and Chronic Health Evaluation II and Mannheim Peritonitis Index scores among the three groups, whereas the amount of subdiaphragmatic free air did not differ.

Comparison of mannheim peritonitis index and revised multiple organ failure score in predicting mortality and morbidity of patients with secondary peritonitis

Background: Secondary peritonitis carries high mortality and morbidity. Many scoring systems have been designed to assess its severity. This study was undertaken to compare the Mannheim peritonitis index (MPI) and revised multiple organ failure score (Revised MOFS) in predicting the mortality and morbidity.Methods: A prospective observational study was undertaken in adults operated for gastrointestinal perforation. Clinical and biochemical parameters as required for MPI and Revised MOFS were recorded. Each of the scores were divided under four categories; MPI &lt;14, 14-21, 22-29 and &gt;29; Revised MOFS 0, 1, 2 and &gt;2. Data was compared for predicting mortality and morbidity. P-value, ROC curve and 95% CI were used as statistical tools.Results: Two thirds of 120 patients studied presented after 48 hours. MPI score of &lt;14, 14-21, 21-29 and &gt;29 had mortality of 0%, 2.2%, 27.2% and 50% respectively. ROC curve showed highest sensitivity and specificity of 79% and 70% respectively at MPI of 25. Significant value for mortality was obtained with MPI &gt;25 (p= 0.000012) and with Revised MOFS &gt;1 (p&lt; 0.001); for morbidity with MPI &gt;21 (p= 0.010) and with Revised MOFS &gt;1 (p&lt; 0.001). 20% patients with Revised MOFS zero were also morbid.Conclusions: Both MPI and Revised MOFS systems are good in predicting the mortality, but MPI is easy scoring system and a better option for predicting morbidity. MPI score &gt;25 for mortality and &gt;21 for morbidity are significant.

A prospective study to evaluate the utility of Mannheim peritonitis index in predicting prognosis of perforation peritonitis at our tertiary care centre

Background: This study was aimed to evaluate the validity of Mannheim Peritonitis Index (MPI) in predicting the outcome in patients with perforation peritonitis.Methods: A prospective study was designed for a study period of 2 years, 75 patients who underwent operation for perforation peritonitis were included in the study. Post evaluation done with predesigned proforma, MPI score was calculated and analyzed for each patient who underwent surgery, death being the main outcome measure. The MPI scores were divided into three categories. MPI scores &lt;15 (category 1), 16-25 (category 2), and &gt;25 (category 3).Results: Present study consisted of 60 males and 15 females (male:female ratio of 4:1) with the mean patients age 37.96±17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3. The dominating source of perforation was small intestinal. The individual parameters of MPI score were assessed against the mortality, age &gt;50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002), and generalized peritonitis (P = 0.0001) were the factors significantly associated with mortality. The sensitivity of MPI was 92% and specificity was 78% in receiver operating characteristic curves.Conclusions: MPI is an effective tool for prediction of mortality in cases of perforation peritonitis.

Hartmann's Procedure or Primary Anastomosis for Generalized Peritonitis due to Perforated Diverticulitis: A Prospective Multicenter Randomized Trial (DIVERTI)

About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma results in lower mortality rates than Hartmann's procedure (HP) in patients with diverticular peritonitis. We conducted a multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI (Primary vs Secondary Anastomosis for Hinchey Stage III-IV Diverticulitis) trial. Follow-up duration was up to 18 months. A random sample of 102 eligible participants with purulent or fecal diverticular peritonitis from tertiary care referral centers and associated centers in France were equally randomized to either a PA arm or to an HP arm. Data were analyzed on an intention-to-treat basis. The primary end point was mortality rate at 18 months. Secondary outcomes were postoperative complications, operative time, length of hospital stay, rate of definitive stoma, and morbidity. All 102 patients enrolled were comparable for age (p= 0.4453), sex (p= 0.2347), Hinchey stage III vs IV (p= 0.2347), and Mannheim Peritonitis Index (p= 0.0606). Overall mortality did not differ significantly between HP (7.7%) and PA (4%) (p= 0.4233). Morbidity for both resection and stoma reversal operations were comparable (39% in the HP arm vs 44% in the PA arm; p= 0.4233). At 18 months, 96% of PA patients and 65% of HP patients had a stoma reversal (p= 0.0001). Although mortality was similar in both arms, the rate of stoma reversal was significantly higher in the PA arm. This trial provides additional evidence in favor of PA with diverting ileostomy over HP in patients with diverticular peritonitis. ClinicalTrials.gov Identifier: NCT00692393.

Laparoscopic repair of perforated peptic ulcer: simple closure versus omentopexy

BackgroundThis report presents our experience with laparoscopic repair performed in 118 consecutive patients diagnosed with a perforated peptic ulcer (PPU). We compared the surgical outcome of simple closure with modified Cellan-Jones omentopexy and report the safety and benefit of simple closure. MethodsFrom January 2010 to December 2014, 118 patients with PPU underwent laparoscopic repair with simple closure (n = 27) or omentopexy (n = 91). Charts were retrospectively reviewed for demographic characteristics and outcome. The data were compared by Fisher's exact test, Mann-Whitney U test, Pearson's chi-square test, and the Kruskal-Wallis test. The results were considered statistically significant if P < 0.05. ResultsNo patients died, whereas three incurred leakage. After matching, the simple closure and omentopexy groups had similarity in sex, systolic blood pressure, pulse rate, respiratory rate, Boey score, Charlson comorbidity index, Mannheim peritonitis index, and leakage. There were statistically significant differences in age, length of hospital stay, perforated size, and operating time. Comparison of the operating time in the ≤4.0 mm and 5.0-12 mm groups revealed that the simple closure took less time than omentopexy in both groups (≤4.0 mm, 76 versus 133 minutes, P < 0.0001; 5.0-12 mm, 97 versus 139.5 minutes; P = 0.006). ConclusionsCompared to the omentopexy, laparoscopic simple closure is a safe procedure and shortens the operating time.

Non-traumatic acute peritonitis in children: causes and prognosis in 226patients at the National Hospital of Zinder, Niger.

To report etiological and prognostic characteristics of acute peritonitis in children. This retrospective study reviewed the records for a 30-month period (January 2013-June 2015) at Zinder National Hospital (Niger) of all children between the ages of 0-15years who underwent surgery for non-traumatic acute peritonitis. Statistical tests were performed, with significance defined by a P-value <5%. Acute peritonitis accounted for 62.12% (226/358) of all emergency gastrointestinal surgery in children. Their median age was 10years (range: 0-15 years), with almost two-thirds of them male (n=148). Ileal perforation, presumably due to typhoid fever, was the main cause (n=153), with acute appendicular peritonitis in second place, accounting for 25.22% (n=57) of cases. Gastrointestinal ostomy was performed in 101patients (44.7%) and an appendectomy in 56 (24.8%). The average length of stay was 10.9±3.6 days. Postoperative complications, defined by the Clavien-Dindo classification, occurred in 46.5% of these procedures (n=105). Surgical site infections were recorded in 66cases. Overall mortality was 13.7% (n=31) and was statistically associated with an American Society of Anesthesiologists (ASA) score of IV (OR = 3,32 : 1,07-10,27 ; P = 0,037) and Mannheim Peritonitis Index (MPI) ≥ 26 (OR = 44,68 : 10,17 - 196,32 ; P = 0,000), time to admission (OR = 4,626 : 1,39 - 15,34, P = 0,012), and time to surgery in hours (OR = 4,59 : 1,60 - 13,18 ; P = 0,0046). In Niger, perforation apparently due to typhoid is the main cause of peritonitis in children. Mortality is associated with an ASA score of IV, Mannheim Peritonitis Index ≥ 26, time to admission, and time to surgery.

Prognostic factors in patients with acute mesenteric ischemia.

Acute mesenteric ischemia, one of the causes of acute abdominal pain due to occlusion of the superior mesenteric artery, has a fatal course as a result of intestinal necrosis. There is no specific laboratory test to diagnose acute mesenteric ischemia. The basis of treatment in cases of acute mesenteric ischemia is composed of early diagnosis, resection of intestinal sections with infarction, regulation of intestinal blood flow, second look laparotomy when required, and intensive care support. The aim of this study is to investigate the factors affecting mortality in patients treated and followed-up with a diagnosis of acute mesenteric ischemia. Forty-six patients treated and followed-up with a diagnosis of acute mesenteric ischemia between January 1st, 2008 and December 31st, 2014 at the General Surgery Clinic of our hospitalwere retrospectively evaluated. The patients were grouped as survivor (Group 1) and dead (Group 2). Age, gender, accompanying disorders, clinical, laboratory and radiologic findings, duration until laparotomy, evaluation according to the Mannheim Peritonitis Index postoperative complications, surgical treatment applied, and type of ischemia and outcome following surgery were recorded. A total of 46 patients composed of 22 males and 24 females with a mean age of 67.5±17.9 and with a diagnosis of mesenteric ischemia were included in the study. Twenty-seven patients died (58.7%) while 19 survived (41.3%). The mean MPI score was 16.8±4.7 and 25.0±6 in Group 1 and Group 2, respectively, and the difference between the two groups was statistically significant (p<0,001). Fourteen of the 16 (51.9%) patients who had a Mannheim Peritonitis Index score of 26 or higher died while two of them survived (10.5%). Thirteen out of the 30 (48.1%) patients with a Mannheim Peritonitis Index score of 25 or lower died while 17 (89.5%) patients survived. The increased MPI score was significantly correlated withmortality (p=0.004). Suspicion of disease and early use of imaging in addition to clinical and laboratory evaluations are essential in order to decrease mortality rates in acute mesenteric ischemia. Prevention of complications with critical intensive care during the postoperative period aids in decreasingthe mortality rate. In addition, using the Mannheim Peritonitis Index can be helpful.

A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation

Background: The identification and early assessment of peritonitis patient is often required in surgical emergency to select the high risk patients for intensive management for better outcome. This is a comparative study of efficacy between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation.Methods: Comparative and prospective study in 50 patients of hollow viscous perforation admitted and operated in surgical emergency, Patna Medical College and Hospital from year April 2014 to April 2016 was done. Mannheim peritonitis index and APACHE II score of each case was calculated and the prediction of outcome was compared with the final outcome.Results: In this study with MPI score &gt;25, 22.8% patients expired. MPI score between 25-15, 6.6% patients expired and with score ≤14 none of the patient expired. According to APACHE II system with APACHE II score less than 10, 8.6% patients expired. Between score 11 -20, 36% expired and With APACHE II score above 20, none of the patients survived I.e. 100% mortality.Conclusions: MPI score is easy to apply and easy to calculate but APACHE II score obviously shows more accurate prediction of mortality.

Evaluation of Mannheim Peritonitis Index in predicting the prognosis of hollow viscus perforation

Background: Peritonitis due to hollow viscous perforation continues to be one of the most common surgical emergencies and a potentially life threatening condition. Its accurate diagnosis and management is still a challenge to surgeons worldwide. A scoring system should be able to assess the need, type, and quality of the care required for a particular patient. Realizing the need for a simple and accurate scoring system in these conditions, the present study was undertaken to evaluate the performance of Mannheim peritonitis index (MPI) scoring system in predicting the overall risk of morbidity and mortality in patients with peritonitis due to hollow viscous perforation. Objective: To predict the risk of mortality and morbidity in patients with peritonitis due to hollow viscous perforation in a sample study of 100 patients and to study the prognostic factors which determine the outcome of the disease. Materials and Methods: This study is a clinical, prospective, observational, and open study conducted at NRI Medical College and General Hospital during a period of 2 years on 100 patients. MPI scoring system was done in all patients and patients were classified according the scores into 3 groups. Result: MPI scoring system was done on all patients depending on preoperative and intraoperative finding and patients were categorized into the three categories. In the score group of 29 it is observed that, 15.78% had morbidity and 84.22% had mortality. A threshold index score of MPI is derived at 27 for predicting the mortality with a sensitivity of 80%, specificity of 91.94% and a PPV = 76.19%. Conclusion: The results of this study proves that MPI scoring system is a simple and effective tool for assessing this group of patients, and can be used as a guiding tool to decide on the management of the patient after the definitive procedure is done.

Mannheim Peritonitis Index Scoring System as Predictor of Prognosis in Acute Peritonitis

Mannheim Peritonitis Index Scoring System as Predictor of Prognosis in Acute Peritonitis