Comparison of predictive values of Mannheim peritonitis index, acute physiology and chronic health evaluation-II and Portsmouth-POSSUM scoring systems for prognosis of mortality in patients with perforation peritonitis
Keywords:Perforation peritonitis, Scoring tools, MPI, APACHE-II, p-POSSUM, Mortality
Background: Perforation peritonitis has emerged as one of the very common cause of surgical emergencies, particularly in developing countries like India. If left untreated for long due to improper prognosis or late diagnosis, perforation peritonitis may prove potentially fatal with a high mortality and morbidity rate. Scoring systems like APACHE-II (acute physiology and chronic health evaluation), p-POSSUM (Portsmouth-POSSUM) and MPI (Mannheim peritonitis index) may serve as simple, critical, and efficient prognostic tools in predicting the mortality in patients with perforation peritonitis. Thus, the aim of the current investigation was to examine the usefulness and accuracy of these scoring systems for predicting the mortality rate in perforation peritonitis.
Methods: Current study was a prospective observational comparative study conducted at department of general surgery, KK Hospital, Lucknow. Detailed clinical and lab investigations of the participating patients were done and their demographic details were documented. Using history, clinical examination and lab values p-POSSUM, APACHE-II and MPI scores were calculated. Scores of each scoring system were statistically analyzed in prognosticating the mortality rate.
Results: Mean age of the participating patients was 41.24±19.32 years. Abdominal pain and vomiting were observed as the most common symptoms in majority of patients. No mortality was observed in patients with ≤20 MPI score, ≤20 APACH-II scores and ≤55 p-POSSUM score. Whereas mortality rate was observed to be 21.53% in patients with >20 MPI score, 82% in >20 APACH-II scores and 78% in >55 p-POSSUM score.
Conclusions: APACHE II and p-POSSUM scores had a higher sensitivity and specificity in comparison to MPI for predicting the mortality in perforation peritonitis.
Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study. Pan Afr Med J. 2011;9:22.
Nag DS, Dembla A, Mahanty PR. Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. World J Clin Cases. 2019;7(16):2227-37.
Hu ZW, Xin RQ, Xia YJ, Jia GP, Chen XX, Wang S. Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery. Clin Interv Aging. 2020;15:1121-8.
Nag DS. Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies. Biomedicine. 2015;5(4):20.
Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India--review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.
Budamala S, Penugonda A, Prakash GV. Evaluation of various prognostic factors in perforative peritonitis management. J Evid Based Med Healthcare. 2015;2(38):6027-35.
Wacha H, Linder MM. Mannheim peritonitis index-prediction of risk of death from peritonitis; construction of a static and validation of an empirically based index. Theoret Surg. 1987;1:169-77.
Halim DA, Murni TW, Redjeki IS. Comparison of Apache II, SOFA, and Modified SOFA Scores in Predicting Mortality of Surgical Patients in Intensive Care Unit at Dr. Hasan Sadikin General Hospital. Crit Care Shock. 2009;12:157-69.
Bohen J, Boulanger M, Meakins JL, Mc lean APH. Prognosis in generalized peritonitis: relations to cause and risk factors. Arch Surg. 1983;118:285-90.
Adesunkanmi ARK, Ajao OG. The prognostic factors in Typhoid ileal perforation. A prospective study of 50 patients. J Roy Coll Surg Edinb. 1997;42:395-9.
Kumar P, Singh K, Kumar A. A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation. Int Surg J. 2017;4:690-6.
Rogy M, Függer R, Schemper M, Koss G, Schulz F. The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score. Chirurg. 1990;61(4):297-300.
Demmel N, Muth G, Maag K, Osterholzer G. Prognostic scores in peritonitis; Mannheim Peritonitis Index or APACHE II? Langenbecks Arch Chir. 1994;379(6):347-52.
Correia MM, Thuler LC, Velasco E, Vidal EM, Schanaider A. Prediction of death using the Mannheim peritonitis index in oncologic patients. Rev Bras Cancerologia. 2001;47:63-8.
Malik A. Turkish J of Trauma and Emergency surgery. Ulus Travma Acil Cerrahi Derg. 2010;16(1):27-32.
Fugger R, Rogy M. Validation study of the Mannheim peritonitis index. Chirurg. 1988;59:598-601.
Ghooi AM, Panjwani S. Acute abdominal emergencies: Clinical overview. Ind J Surg 1978;140:182-9.
Hobson SA, Sutton CD, Garcea G, Thomas WM. Prospective comparison of POSSUM and PPOSSUM with clinical assessment of mortality following emergency surgery. Acta Anaesthesiol Scand. 2007;51(1):94-100.
Kitara DL, Kakande I, Mugisa BD. POSSUM scoring system in patients undergoing laparotomy in Mulago Hospital. East and Central African J Surg. 2006;12(2):133-42.
Ohmann C, Wittmann DH, Wacha H. Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group. Eur J Surg. 1993;159:267-74.
Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D, Crucitti F. Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg. 1996;131(6):641-5.