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 >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.

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 <21, the mortality rate was 0%; for score 21–29, it was 4.3%; and for score >27, it was 67.9% (P < 0.001). Age> 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.

EFFECTIVENESS OF MANNHEIM PERITONITIS INDEX IN PREDICTING THE MORBIDITY AND MORTALITY OF PATIENTS WITH PERITONITIS FOLLOWING HOLLOW VISCUS PERFORATION

Background: One of the common cause of emergency surgery in India is peritonitis due to hollow viscous perforation. The morbidity and mortality of secondary peritonitis remains high despite advances in surgical skills, antimicrobial agents and supportive care. Many factors determine the prognosis and outcome which includes patient related factors, disease specific factors and management of the case. Management of these case are done by categorizing patients into different risk groups. Based on measuring simple clinical parameters in case of hollow viscous perforation Mannheim peritonitis index (MPI) is calculated. To know efficacy of MPI for predicting morbidity and mortality in hollow viscous perforation this study was conducted. Methods: 50 patients who were undergoing surgical treatment for peritonitis following hollow viscous perforation at Silchar Medical College and Hospital, Silchar were included in study. Clinical data, surgical treatment, outcome were documented and analysed. Results: In patients with MPI more than 29 the morbidity and mortality rate were higher. The most common complication in patients with MPI less than 21 was surgical site infection while of those with MPI more than 21 the respiratory complications were common. The ICU stay of the patients were increased if the MPI Score was higher. Conclusions: MPI is simple and effective in predicting morbidity and mortality in patients with hollow viscous perforation and is very easy to calculate.

MPI score assessment of perforation peritonitis patients

The most widespread clinical emergency in India is perforation peritonitis. Following improvements in operational procedures, antimicrobial treatments, and care in ICUs, peritonitis control is often very complicated, complicated, and challenging. MPI provides the highest precision of risk-assessment such that specific predictions for patients with peritonitis could be estimated. The objective of this research is to determine the prognosis for perforated peritonitis patients using the peritonitis index from Mannheim. It is also targeted at a) assessing the results in Mannheim peritonitis test perforation cases b) evaluating elevated incidents of perforated peritonitis on the Peritonitis Scale with Mannheim. C) Determining the function of the Mannheim Peritonitis Index in decision-making on peritonitis surgery. This research measured the diagnosis of perforated peritonitis patients utilizing peritonitis score of Mannheim’s Index. In the present study, we observed that the majority of the study subjects were males (65.38%), and many of the cases ranged from the age group of 46-55 years (25%), as well as 36-45 years (23.07%). The majority of the cases had duodenal perforation (42.30%), followed by gastric perforation (28.84%), appendicular perforation (13.46%), filial perforation (9.61%), jejunal (3.8%), colonic perforation (1.9%). We observed that the majority of the study subjects reported the MPI score between 21-29 (46.15%), followed by (38.46%) cases who reported MPI score of more than 29, and 15.38% who reported MPI score less than 21.

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 <50 years and 46% patients were in the age group >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 >24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was <21 while 25 (25%) patients total score was 21-29 and it was >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.

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: <21, 21 to 29 and >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 >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.