Prediction of Outcome Using the Mannheim peritonitis Index in Patients with Peritonitis at Kigali University Teaching Hospital|
Ntirenganya, F.; Ntakiyiruta, G. & Kakande, I.
Background: Successful management of peritonitis has, for decades, presented a challenge to
surgeons despite advancements in medicine. This led to the development of disease severity grading
systems that would aid in stratifying patients by individual risk factors and hence appropriately
predict possible outcome. The objectives of this study was to evaluate the Mannheim peritonitis
index (MPI) in determining the outcome in patients operated for peritonitis at KUTH and to
determine the MPI sensitivity and specificity in predicting outcome.
Methods: The study population consisted of 100 consecutive patients with peritonitis who
underwent surgical treatment at Kigali University Teaching Hospital. Patients were enrolled in the
study after signing an informed consent. A pre-established questionnaire was filled for all patients
registered during the study period. Socio-demographic, clinical, paraclinical, management and
outcome were recorded and analyzed using epidata and SPSS software programs. Pearson's Chisquare
was used as a statistical test and considered as showing a significant difference if p was
equal or less than 0.05.
Results: The mean MPI was 26.78 ±6.32 points with 10 points as the lowest and 39 points as the
highest score. 44% of our patients had an MPI score between 21and 29. No death noted below 21 of
MPI score. MPI score groups were influencing mortality, complications, reoperations and hospital
stay with p- values ≤ 0.001. The most significant predictive factors for morbidity/mortality in this
study were the presence of organ failure, the presence of malignancy, the duration of symptoms of
more than 24hours, the source of sepsis, the extent of peritonitis, and the presence of fecal
peritoneal fluid. However, gender and age were not significant predictors. The ROC curve for
mortality showed a predictive power of 0.903 with a sensitivity of 88.2% and a specificity of 74.8%
at an MPI of 29 points. In this study, the predictive power of the MPI for morbidity was 0.896 with
a sensitivity of 66.7% and a specificity of 99.04% at a score of 29 points.
Conclusion: The MPI score can provide simple and objective means to predict the outcome of
patients with peritonitis at KUTH.