A PROSPECTIVE OBSERVATIONAL STUDY ON THE EFFECTIVENESS OF THE MANNHEIM PERITONITIS INDEX IN PREDICTING MORTALITY AMONG PATIENTS WITH GASTRODUODENAL PERFORATION PERITONITIS

Abstract

Peritonitis is a life-threatening inflammatory condition of the peritoneum or peritoneal cavity, most commonly arising from localised or generalised infection and frequently associated with gastrointestinal perforation. ^[1]

Its diagnosis is largely clinical, relying on a detailed patient history and comprehensive physical examination, although radiological and laboratory investigations may provide supportive evidence. ^[2]

The prognosis of perforation peritonitis is influenced by a complex interplay of host factors, disease severity, and the timeliness of therapeutic intervention. Early recognition and prompt surgical management are critical, as delays often result in rapid progression to sepsis, intra-abdominal contamination, and ultimately multiorgan dysfunction. ^[3]

Despite advancements in surgical techniques, including radical peritoneal debridement, extensive lavage systems, planned re-exploration strategies, and open abdomen management, the morbidity and mortality associated with secondary peritonitis remain substantial, particularly when complicated by organ failure. Given this persistent clinical challenge, objective tools that accurately stratify disease severity and predict patient outcomes have become indispensable in optimising management strategies for critically ill patients. ^[4][5][6]

Several prognostic scoring systems have been developed to assess the severity of intra-abdominal infection and estimate mortality risk, such as the Mannheim Peritonitis Index (MPI), Peritonitis Index Altona (PIA), Sepsis Score, the Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM). ^[7]

Among these, the MPI, introduced by Wacha and Linder in 1983 after the analysis of 1,253 patients with peritonitis, has gained prominence due to its simplicity, reproducibility, and reliance on only eight independently significant prognostic variables. The index demonstrates reliable sensitivity and specificity and is particularly advantageous in resource-limited settings where access to advanced diagnostic modalities is constrained. Its ease of application and strong prognostic accuracy make the MPI a practical and widely accepted tool for guiding clinical decision-making in patients with secondary peritonitis, including those with gastroduodenal perforations. ^[8][9]