Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study

Abstract

Postoperative peritonitis (PoP), despite their relatively low incidence, are associated with high mortality. Such poor outcomes are also related to the high proportion of aged patients, whose intra-abdominal infections are difficult to manage. The study included 84 consecutive patients with PoP. The aim was the validation of the Mannheim Prognostic Index (MPI) in the context of PoP and the assessment of the prognostic impact of age and other clinical factors in a large series from a tertiary center. PoP had an incidence of 3.9% in all the abdominal surgeries in the study period. Surgical control of POP focus was achieved in 90.5% of cases and a complete abdominal clearance in 58.3%. Complication rate was 75% with a mortality of 26.2%. For MPI score, the ROC curve indicated a cut-off value of 29 with a sensitivity of 72.7% and specificity of 67.7% in predicting death. At univariate analysis, factors significantly related to poorer prognosis included advanced age (p 0.001), site of primary surgery (p 0.05), lack of abdominal clearance (p 0.003), generalized peritonitis (p 0.04) and high MPI score (p < 0.001). Age, MPI score and absence of abdominal clearance resulted in independent prognostic factors at multivariate analysis. MPI showed good efficacy in identifying POP patients at high risk of death. The increased risk of mortality related to advanced age should be considered with MPI score in planning the treatment. An aggressive and early diagnostic-therapeutic approach is required to reduce the MPI score and improve the prognosis.

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References

  1. 1.

    Mulier S, Penninckx F, Verwaest C et al (2003) Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg 27:379–384. https://doi.org/10.1007/s00268-002-6705-x

    Article  PubMed  Google Scholar 

  2. 2.

    Ruggiero R, Sparavigna L, Docimo G et al (2011) Post-operative peritonitis due to anastomotic dehiscence after colonic resection. Multicentric experience, retrospective analysis of risk factors and review of the literature. Ann Ital Chir 82:369–376

    PubMed  Google Scholar 

  3. 3.

    Sartelli M, Chichom-Mefire A, Labricciosa FM et al (2017) The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 12:29. https://doi.org/10.1186/s13017-017-0141-6

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Sartelli M, Griffiths EA, Nestori M (2015) The challenge of post-operative peritonitis after gastrointestinal surgery. Updates Surg 67:373–381. https://doi.org/10.1007/s13304-015-0324-1

    Article  PubMed  Google Scholar 

  5. 5.

    Bassetti M, Eckmann C, Giacobbe DR et al (2019) Post-operative abdominal infections: epidemiology, operational definitions, and outcomes. Intensive Care Med 46:163–172

    Article  Google Scholar 

  6. 6.

    Torer N, Yorganci K, Elker D, Sayek I (2010) Prognostic factors of the mortality of postoperative intraabdominal infections. Infection 38:255–260. https://doi.org/10.1007/s15010-010-0021-4

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360. https://doi.org/10.1002/bjs.1800780327

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kulkarni SV, Naik AS, Subramanian N (2007) APACHE-II scoring system in perforative peritonitis. Am J Surg 194:549–552. https://doi.org/10.1016/j.amjsurg.2007.01.031

    Article  PubMed  Google Scholar 

  9. 9.

    Kumar S, Gupta A, Chaudhary S, Agrawal N (2011) Validation of the use of POSSUM score in enteric perforation peritonitis—results of a prospective study. Pan Afr Med J. https://doi.org/10.4314/pamj.v9i1.71197

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Wacha H, Linder MM, Feldmann U et al (1987) Mannheim peritonitis index - prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theor Surg 1:169–177

    Google Scholar 

  11. 11.

    Muralidhar VA, Madhu CP, Sudhir S, Srinivasarangan M (2014) Efficacy of Mannheim Peritonitis Index (MPI) score in patients with secondary peritonitis. J Clin Diagnostic Res 8:NC01–NC03. https://doi.org/10.7860/JCDR/2014/8609.5229

    Article  Google Scholar 

  12. 12.

    Neri A, Marrelli D, Scheiterle M et al (2015) Re-evaluation of mannheim prognostic index in perforative peritonitis: prognostic role of advanced age. A prospective cohort study. Int J Surg 13:54–59. https://doi.org/10.1016/j.ijsu.2014.11.035

    Article  PubMed  Google Scholar 

  13. 13.

    Salamone G, Licari L, Falco N et al (2016) Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis. G Chir 37:243–249. https://doi.org/10.11138/gchir/2016.37.6.243

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  15. 15.

    Correia MM, Thuler LCS, Velasco E et al (2001) Prediction of death using the Mannheim peritonitis index in oncology patients. Rev Bras Cancerol 47(1):63–68

    Google Scholar 

  16. 16.

    Billing A, Fröhlich D, Schildberg W (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg 81:209–213. https://doi.org/10.1002/bjs.1800810217

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Solomkin Joseph S, Mazuski John E, Bradley John S, Rodvold Keith A, Goldstein Ellie J C, Baron Ellen J, O’Neill Patrick J, Chow Anthony W, Patchen Dellinger E, Eachempati Soumitra R, Gorbach Sherwood, Hilfiker Mary, May Addison K, Nathens Avery B, Robert JGB (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 11:79–109. https://doi.org/10.1086/649554

    CAS  Article  Google Scholar 

  18. 18.

    Malangoni MA (2003) Current concepts in peritonitis. Curr Gastroenterol Rep 5:295–301

    Article  Google Scholar 

  19. 19.

    Bosscha K, Reijnders K, Hulstaert PF et al (1997) Prognostic scoring systems to predict outcome in peritonitis and intraabdominal sepsis. Br J Surg 84:1532–1534. https://doi.org/10.1002/bjs.1800841110

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Mariette C (2006) Principes de prise en charge chirurgicale des péritonites postopératoires. J Chir (Paris) 143:84–87

    CAS  Article  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial or not for- profit sectors.

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AN conceived the study, participated in data collection and analysis, drafted the manuscript. DF conceived the study, participated in statistical analysis and reviewed the manuscript. LM and VS participated in data collection and analysis, provided language help and contributed to the manuscript draft. ABCP and CD participated in data collection and to statistical analysis. FR is the clinical lead and guarantor of the manuscript. DM conceived of the study, participated in its design and coordination and reviewed the final draft. All Authors read and approved the manuscript.

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Correspondence to Daniele Marrelli.

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All procedures performed in this study involving patients were in accordance with the ethical standards of the national research commitee and with the 1964 Helsinki declaration and its later amendments.

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Neri, A., Fusario, D., Marano, L. et al. Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study. Updates Surg 72, 1159–1166 (2020). https://doi.org/10.1007/s13304-020-00831-5

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Keywords

  • Peritonitis
  • Surgery
  • Treatment outcome
  • Prognostic factor
  • Aged
  • Intra-abdominal infections