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


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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Author information




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).

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