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APACHE II and Mannheim Peritonitis Index (MPI) fail to predict lethality in septic peritonitis in immunosuppressed solid organ transplant recipients

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Summary

Background

We investigated the applicability of both Acute Physiology And Chronic Health Evaluation II (APACHE II) and Mannheim Peritonitis Index (MPI) in transplant recipients with intestinal perforation as polymicrobial peritonitis is highly life-threatening in patients with impaired immunological defence and the course of abdominal sepsis is aberrant compared to non-immunosuppressed individuals.

Methods

In a retrospective database analysis, we validated the consistency of APACHE II and MPI in death prediction in septic peritonitis. In a matched-pair analysis we then investigated their applicability in immunosuppressed transplant recipients. The validation of the scores was performed with 125 non-immunosuppressed patients. In a matched-pair analysis 16 immunosuppressed transplant recipients were compared with 32 controls.

Results

In accordance with clinical observations, statistical analyses revealed significantly higher MPI scores in immunosuppressed transplant recipients (P = 0.0007), whereas APACHE II scores were comparable. Linear regression analysis revealed that predicted death rates derived from APACHE II and MPI differ significantly (P = 0.0344) in immunosuppressed transplant recipients compared to controls.

Conclusions

Both scores consistently serve as reliable tools for prediction of lethality in septic peritonitis but they fail in immunosuppressed organ recipients. Our findings clearly confirm that in immunosuppressed patients severe peritonitis might be present despite an a- or oligosymptomatic clinical course.

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Conflict of interest

All authors (Volker Assfalg, Daniel Reim, Edouard Matevossian, Bernhard Holzmann, Klaus Emmanuel, Alexander Novotny, and Norbert Hüser) declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Munich Transplant Center TransplanTUM, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    V. Assfalg MD, D. Reim MD, E. Matevossian MD, B. Holzmann MD, A. Novotny MD & N. Hüser MD

  2. Department of Surgery, Salzburger Landeskliniken, University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    K. L. Emmanuel MD

  3. Department of Surgery, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte 4, 4020, Linz, Austria

    K. L. Emmanuel MD

Authors
  1. V. Assfalg MD
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  2. D. Reim MD
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  3. E. Matevossian MD
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  4. B. Holzmann MD
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  5. K. L. Emmanuel MD
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  6. A. Novotny MD
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  7. N. Hüser MD
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Corresponding author

Correspondence to V. Assfalg MD.

Additional information

A. N. and N.H. contributed equally to this work

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Assfalg, V., Reim, D., Matevossian, E. et al. APACHE II and Mannheim Peritonitis Index (MPI) fail to predict lethality in septic peritonitis in immunosuppressed solid organ transplant recipients. Eur Surg 45, 205–212 (2013). https://doi.org/10.1007/s10353-013-0218-8

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  • DOI: https://doi.org/10.1007/s10353-013-0218-8

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