Effectiveness of Mannheim peritonitis index in predicting the morbidity and mortality of patients with hollow viscous perforation

Background SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which are often not quickly available in a resource limited emergency setting. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary teaching hospital in a low and middle income country like Uganda. Objective To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda. Methods This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high risk, while a score of < 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13. Results A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS. Conclusion SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

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“…There were more males compared to females in this study. A similar observation has been reported by previous studies [ 3 , 9 – 15 ].…”

Section: Discussionsupporting

confidence: 93%

“…Despite the global advances in surgical practice and care, intra-abdominal infections arising from secondary peritonitis still remain one of the most significant causes of morbidity and mortality world over [ 3 ]. In the setting of septic shock, mortality of up to 30% has been reported [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

et al. 2021

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show abstract

“…There were more males compared to females in this study. A similar observation has been reported by previous studies (3,8,(18)(19)(20)(21)(22)(23).…”

Section: Discussionsupporting

confidence: 92%

“…Despite the global advances in surgical practice and care, intra-abdominal infections arising from secondary peritonitis still remain one of the most signi cant causes of morbidity and mortality world over (3).In the setting of septic shock, mortality of up to 30% has been reported (4).In order to accurately predict these adverse outcomes of secondary peritonitis, a number of risk assessment scoring tools have been developed and used with various performance levels in different clinical settings. SIRS and qSOFA are two such ancillary scoring tools that have been used extensively inside and outside the Intensive Care Unit (ICU) setting globally.…”

Section: Introductionmentioning

confidence: 99%

Comparison of QSOFA and SIRS Scores for the Prediction of Adverse Outcomes of Secondary Peritonitis in a Tertiary Teaching Hospital in Uganda: a Prospective Cohort Study

Nkonge

Kituuka

Ocen

2021

Preprint

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Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. Mulago hospital uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However it’s associated with delays in decision making given its partial reliance on laboratory parameters. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool, however its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in Mulago hospital, Uganda.Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis in Mulago hospital, Uganda.Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the A&E, Mulago hospital. QSOFA and SIRS scores were generated for each of the patient, with a score of ≥ 2 recorded as high risk, while a score of ≤ 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS.Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

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Effectiveness of Mannheim peritonitis index in predicting the morbidity and mortality of patients with hollow viscous perforation

Cited by 2 publications

References 3 publications

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

Comparison of QSOFA and SIRS Scores for the Prediction of Adverse Outcomes of Secondary Peritonitis in a Tertiary Teaching Hospital in Uganda: a Prospective Cohort Study

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