Comparison of MPI and APACHE II in the Prognosis of Perforating Peritonitis

Abstract

ABSTRACT Introduction: Peritonitis is an important surgical emergency that a surgeon has to face. Reproducible scoring systems that allow a surgeon to determine the severity of peritonitis are essential to prognosticate the patient. Aim: To evaluate effectiveness of Mannheim Peritonitis Index (MPI) in comparison to Acute Physiology and Chronic Health Evaluation (APACHE) II in assessing prognosis of patients with perforation Peritonitis. Materials and Methods: In this prospective observational study from November 2015 till March 2017, 63 patients above 18 years of age presenting with perforation peritonitis were included. APACHE II and MPI scoring systems were calculated in all the patients in order to assess their individual risk of morbidity and mortality. The outcome variables studied were: Postoperative wound infection, wound dehiscence, anastomotic leak, respiratory complications, duration of hospital stay, need of ventilator support and mortality. The inferences were drawn with the use of statistical software package SPSS v22.0. The tests used were ANOVA, Chi-square analysis and t-test. The p value <0.05 was taken as significant. Results: Out of total subjects of 63, Mean age of male subjects was 37.4 years and female subjects was 38.5 years. The mean APACHE II score of 63 patients was 11.2±8.1 with range of 0 to 35 and the mean MPI score was 26.9±7.2 with range of 6 to 39. APACHE II was able to predict postoperative respiratory complications (p<0.001), postoperative need for ventilatory support (p<0.001), hospital stay duration (p-value <0.05) level and mortality (p-value 0.003) while MPI was able to predict postoperative respiratory complications (p<0.001), postoperative need for ventilatory support (p<0.001) and mortality (p-value 0.025). Neither APACHE II nor MPI could predict postoperative anastomotic leak, postoperative wound infection, and postoperative wound dehiscence. Conclusion: MPI is a useful and simple method to determine outcome in patients with peritonitis and is comparable to APACHE II in assessing the prognosis in perforation peritonitis. It can be used in place of APACHE II score in prognosticating patients of perforation peritonitis.

Keywords

• acute physiology and chronic health evaluation
• mannheim peritonitis index
• outcome variables