Evaluation of Mannheim Peritonitis Index (MPI) in predicting early management and outcome in patients with peritonitis

BACKGROUND AND OBJECTIVE: Peritonitis is one of the common cause of ‘acute abdomen’. It is one of themajor cause of morbidity and mortality worldwide. Despite all the recent advances in the diagnostic and management techniques, peritonitis is a great challenge to medical fraternity. An accurate predictive ability would make it possible to measure more precisely, the quality of intensive care and other new life-saving technologies. Scoring systems that group patients based on the severity of illness before treatment can allow a meaningful analysis of morbidity and mortality rates. Hence I selected a study to evaluate Mannheim Peritonitis Index which is severity scoring system, in predicting outcome in patients with peritonitis. METHODS: Patients with secondary peritonitis managed in the surgical wards and ICU in Coimbatore Medical College Hospital are included in my study. Resuscitation measures, antibiotic therapy, vasoactive drugs, nasogastric intubation and analgesics administered as required. MPI were calculated at admission or during management. All patients will undergo laparotomy and managed according to the cause. After surgery interventions like antibiotic therapy, vasoactive drugs, resuscitation and ICU care given as necessary. Patients followed up until discharge or death. Patients are grouped into three categories based on disease severity those with MPI29. Mortality rates calculated belonging to each group. RESULTS: This study included 100 patients with peritonitis, which showed a male predominance. The ratio is approximately 2:1. Most of the patients belong to age group between 15 to 30.Major cause of post-operative morbidity was wound infection and respiratory complications. 62 cases were in low risk group with nil mortality, 20 cases in moderate risk group with 45% mortality and 18 patients in high risk group with 89% mortality. Duration of hospital stay doesn’t correlate with severity of disease because a patient with MPI score more than 29 succumbs to death in immediate postoperative period. The complications have been most common in the group of patients having a MPI score between 22 to 29, whereas those who have a score above 29 have higher mortality. CONCLUSION: I conclude that Mannheim Peritonitis index (MPI) is simple and objective scoring system to predict the final outcome of patients with peritonitis and intraabdominal sepsis. It appears more practical than other scoring systems. MPI provides an easy and reliable means of risk evaluation and classification for 5 patients with peritoneal inflammation for early intensive management for better outcome of patient