Efficacy of the Mannheim Peritonitis Index (MPI) in Predicting Postoperative Outcomes in Patients With Perforation Peritonitis.

INTRODUCTION

Peritonitis or inflammation of the peritoneum is a leading cause of mortality in surgical patients. Perforation of the gastrointestinal tract (perforation peritonitis) is one of the commonest origins and a rapidly fatal disease. The Mannheim Peritonitis Index (MPI) is a scoring system used to forecast outcomes for individuals suffering from peritonitis that uses a straightforward bedside grading method. This study aimed to determine how well the MPI predicts clinical outcomes for individuals who have perforation peritonitis in an Indian setting.

METHODOLOGY

This study was a prospective observational study conducted over two years at a tertiary care hospital in India with a sample size of 72 patients. The study population comprised patients aged over 18 years who presented to the emergency department with clinical and radiological suspicion of perforation peritonitis, which was later confirmed intraoperatively. Pregnant women and patients below 18 years of age were excluded. The variables found in the MPI were assigned the values indicated, and the total MPI score for each patient was calculated. The cases were then grouped into three groups, viz those with an MPI below 21 points, between 21 and 29 points, and those above 29 points. Patients were followed up, and outcomes were recorded in terms of discharge, morbidity or mortality. Morbidity was specifically measured in terms of surgical site infection, wound dehiscence, intra-abdominal abscess formation, acute renal failure and pulmonary complications.

RESULTS

Higher MPI scores on presentation directly correlated with a greater severity of disease in terms of post-operative morbidity and mortality. The overall mortality rate was 16.7%, with a clear correlation between higher MPI scores and increased mortality. As far as post-operative systemic complications were concerned, patients with a higher preoperative MPI were more likely to develop complications like acute kidney injury and pulmonary complications like pneumonia postoperatively. Surgical site infections occurred in 44.4% of patients, and wound dehiscence in 16.7%. Of the four patients who subsequently developed an intra-abdominal abscess, three had an MPI greater than 29 on presentation.

CONCLUSION

The findings of this study demonstrate that the MPI is a valuable tool for stratifying patients of perforation peritonitis, with higher MPI scores correlating with worse clinical outcomes, including organ failure, wound complications, and mortality. The demographic analysis of our study revealed a significant male predominance and a relatively young patient population, suggesting regional or demographic factors. The high incidence of organ failure, particularly among those with higher MPI scores, underscores the critical nature of perforation peritonitis and the necessity for intensive care support.