Mannheim Peritoneal Index in the Prediction of Postoperative Complications in Patients with Peritonitis

Abstract

Objective: to study the diagnostic and prognostic values of the Mannheim peritoneal index (MPI) in the development of postoperative local and systemic complications in patients with peritonitis. Materials and methods. The case histories of 92 patients with generalized peritonitis of varying etiology (other than pancreatogenic one) were analyzed. The patients were retrospectively divided into 3 groups according to the outcomes and occurrence of postoperative local complications. The postoperative complications were classified by the procedure developed by A. L. Kostyuchenko et al. as local and systemic ones. When the patients had two signs or more of the systemic inflammatory response syndrome, they were stated to have systemic complications and to be diagnosed as having abdominal sepsis with the pattern of organ dysfunctions being described in accordance with the sepsis classification proposed by R. S. Bone et al. (1992). The number of organ dysfunctions was daily counted in each patient over time in the postoperative period. On the first postoperative day, MPI was calculated in scores for each patient; the mean MPI was estimated for all patient groups. The predictable mortality was calculated using the MPI plot. Results. All the patients with generalized peritonitis in the development of local postoperative complications were observed to have sepsis in the postoperative period, without developing local complication in 84.6% of the patients. A direct correlation was found between the MPI and the quantity of organ dysfunctions (r=0.6; p=0.001). In patients with local postoperative complications being developed, the MPI values were higher (p<0.05) than in those without them. The mortality rates that have been predicted by means of MPI (16.3%) and actual (15.2%) are actually in agreement. Conclusion. There is evidence for the diagnostic and prognostic values of MPI in the development of local and systemic postoperative complications in patients with peritonitis. MPI calculation from postoperative day 1 along with later dynamic estimation of the number of organ dysfunctions makes it to objectively assess not only prognosis, but also the pattern of postoperative peritonitis. The major advantage of MPI is the simplicity of calculation, which permits its use in clinics. Key words: peritonitis, prognosis, complications, sepsis, Mannheim peritoneal index.