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

Abstract

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 <14, 14-21, 22-29 and >29; Revised MOFS 0, 1, 2 and >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 <14, 14-21, 21-29 and >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 >25 (p= 0.000012) and with Revised MOFS >1 (p< 0.001); for morbidity with MPI >21 (p= 0.010) and with Revised MOFS >1 (p< 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 >25 for mortality and >21 for morbidity are significant.

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

“…Although MPI scoring system was deemed better or similar to other scoring systems like qSOFA (quick sequential organ failure assessment), APACHE II (acute physiological assessment and chronic health evaluation), and etc. while predicting mortality and morbidity in secondary peritonitis, subsequent sepsis related complications do not reflect well to these scoring systems (26,29,(32)(33)(34)(35). Since the APACHE II and SAPS scoring system measures permanent biochemical changes and organ insufficiency for predicting mortality and morbidity, it becomes unreliable to patients developing septic shock post operatively within 24 hours (36).…”

“…Mortality rates were significantly higher (>20%) in studies due to high evolution time (>24 hours), diffused nature of peritonitis with associated infection in exudate cultures and comorbidity parameters like sepsis and organ failure. One of the major reasons for such association might be due to delayed presentation, under-developed health care system, unavailability of critical care and delay in early intervention resulting in development of sepsis, SIRS (systemic inflammatory response syndrome) and MODS (multi organ dysfunction syndrome) (29,(32)(33)(34)(35)). From our MPI based studies, we speculate the risk category of peritonitis patients with MPI score as <21 (low risk), 21-29 (moderate risk) and >29 (high risk) as a better assessment parameter to predict treatment modalities and outcomes.…”