Ghosh Ankan, Halder Anindya, Sen Nirmalya, Dhara Aiindrila, Ghosh Sourav, Stellone Singh Khulem
Department of General Surgery, All India Institute of Medical Sciences, Kalyani, India.
Division of Molecular Medicine, Bose Institute, Kolkata, India.
Turk J Surg. 2023 Dec 29;39(4):300-309. doi: 10.47717/turkjsurg.2023.6043. eCollection 2023 Dec.
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 The 10-site study results were compared with unpublished in-house study data for individual MPI parameters to analyze any variations of MPI score-based predictions across a diverse Indian population.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.
继发性腹膜炎是由消化道穿孔导致的腹腔感染引起的。曼海姆腹膜炎指数（MPI）是一种预测腹膜炎预后的评分系统。MPI评分升高与不良预后和死亡率相关。本研究的目的是评估基于MPI的预后评估的有效性及其对印度继发性腹膜炎患者的影响。
为了解MPI评分系统的有效性，对来自印度10个地理位置的已发表的继发性腹膜炎研究进行横断面数据分析。将10个地点的研究结果与未发表的关于各个MPI参数的内部研究数据进行比较，以分析在不同印度人群中基于MPI评分预测的任何差异。根据MPI评分将患者分为风险组：MPI<21为轻度，MPI = 21 - 29为中度，MPI>29为重度风险。
我们观察到，如全球报道的那样，死亡率与年龄和性别之间存在显著相关性。在印度人群中，穿孔部位以上消化道为主，大多数为胃十二指肠穿孔，而西方人群中穿孔部位以远端为主。由于就诊延迟和管理不善，印度较高的致死率往往与病情进展时间、器官衰竭和脓毒症有关。
MPI评分在预测不同地理位置的印度人群的风险方面是有效的。MPI评分的敏感性和特异性更可靠，评分>29特别建议对患者进行积极的复苏和监测，启动广谱抗生素治疗，并给予重症监护支持，以降低死亡率和发病率。
