Evaluation of Mannheim Peritonitis Index to Predict Outcome of Patients with Peritonitis

INTRODUCTION: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. The peritoneum, which is an otherwise sterile environment, reacts to a variety of pathologic stimuli with a fairly uniform inflammatory response. Depending on the underlying pathology, the resultant peritonitis may be infectious or sterile (i.e, chemical or mechanical). Peritonitis is most often caused by introduction of an infection into the otherwise sterile peritoneal environment through organ perforation, but it may also result from other irritants, such as foreign bodies, bile from a perforated gall bladder or a lacerated liver, or gastric acid from a perforated ulcer. Women also experience localized peritonitis from an infected fallopian tube or a ruptured ovarian cyst. Patients may present with an acute or insidious onset of symptoms, limited and mild disease, or systemic and severe disease with septic shock. Peritoneal infections are classified as primary (ie, from hematogenous dissemination, usually in the setting of immunocompromise), secondary (ie, related to a pathologic process in a visceral organ, such as perforation, trauma, or postoperative), or tertiary (ie, persistent or recurrent infection after adequate initial therapy). AIM OF STUDY: A study to confirm the predicative value of MPI among patients with intraoperative diagnosis of peritonitis at the surgical department, to evaluate severity of peritonitis and to make a prognosis of survivalmortality, considering the risk factors analyzed in this index. PATIENTS AND METHODS: A prospective, descriptive, transversal and observational study was undertaken. Patients included were all male and female patients, 14 years of age or older, seen at the Surgical Service. with diagnosis of peritonitis confirmed during surgery regardless of etiology. Once diagnosis of peritonitis had been determined by operative findings registered in the postoperative report, the patient was accepted into the study. Using data recollection sheets, risk factors found in MPI were classified according to values indicated in Table I and individual variable scores were added to establish initial MPI score. In addition to personal data such as name, age, sex, etc.,the following intrahospital information was registered: file number; dates of admission and discharge from the hospital; days hospitalized; date of surgery and information related to illness (surgical findings, medical treatment and evolution of illness). Patient evolution was followed, indicating presence of complications and discharge due to improvement or death. Time elapsed from initial diagnosis to moment of event (death or discharge from hospital) was determined. The minimum possible score was zero, if no adverse factor were present, and maximum was 47 if presence of all were confirmed. Patients were divided in three groups according to the following categories (MPI points) fewer than 15; from 16 to 25, and more than 25. . A life table, using the actuaria method, was constructed to compare patient survival with peritonitis severity according to MPI score. To determine significance of possible differences among three categories (25 points). RESULTS: From Jan 2009 to Nov 30 2010 of about 150 patients with peritonitis confirmed during surgical intervention were admitted to the Surgical Service,except one patient treated conservatively by bilateral flank drain due to Ca cervix on radiotherapy. Study Group General Data: Of the sample of 150 patients, 28 were female (18.7%) and 122were male (81.3%). Group mean age was 41.8 years with a median of 40 years and a range from 14 years and above. Mean age of survivors was 39.78 years of age (± 13.8); among non-survivors, mean age was 53 years (± 11.3) (p < 0.0001). Of the 150 patients 149 were operated and one was bilateral flank drain, 23 (15.3%) died (global mortality 6%), 17 (11.4%) were wound sepsis and 110 (73.3%) were discharged without complication. Origin of peritonitis was from more than 6 different anatomic sites and was due to various causes. Mannheim Criteria Data: Group mean MPI score was 18 points. Among surviving patients, mean score was 16 points and among non-survivors, mean was 27 points (p 25) have differences that are statistically significant. succinctly, break down information of each risk factor according to the following categories: a) MPI scores 25, Results of Odds ratio for each risk factor, for age over 50 years is 5.346 and Gender is 0.(Chart-2.1 to 5.1). CONCLUSION: MPI is a useful method to determine study group outcome in patients with peritonitis surgically evaluated. All MPI adverse factors, except colonic origin, behaved as expected, and the following were especially useful: presence of the organic failure; time elapsed > 24 h; presence of malignity; age > 50 years, and generalized extension of peritonitis. MPI, together with surgeon’s clinical judgment of each case, may be another possible use of this score, aiding the surgeon in making the always difficult decision of reintervention in a patient