DOI: 10.4103/sujhs.sujhs_8_26 ISSN: 2773-1987

A prospective observational study using the Mannheim Peritonitis Index to forecast the course of secondary peritonitis patients

Aniyat Sheikh, Aasif Ahmad, Zubair Rashid, Jasir Ahmad Bhat
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ABSTRACT

Background:

Secondary peritonitis is a life-threatening surgical emergency associated with significant morbidity and mortality. The Mannheim Peritonitis Index (MPI) is a simple intraoperative scoring system used to predict mortality and morbidity in patients with peritonitis. This study aimed to prospectively validate the predictive accuracy of the MPI in patients with secondary peritonitis in a tertiary care setting.

Materials and Methods:

A prospective observational study was conducted over 2 years from December 2024 to June 2025. A total of 182 patients with intraoperatively confirmed secondary peritonitis were included. MPI scores were calculated based on eight established risk factors. Patients were stratified into three risk groups: MPI ≤ 20, MPI 21–29, and MPI ≥ 30. The primary outcome was inhospital mortality, while secondary outcomes included postoperative complications and length of hospital stay. Statistical analysis was performed using SPSS version 25.0.

Results:

The overall mortality rate was 9.8% ( n = 18). Mortality rates increased significantly across MPI groups: 0.85% (1/117) in MPI ≤20, 2.5% (1/40) in MPI 21–29, and 64% (16/25) in MPI ≥ 30 ( P < 0.0001). The mean MPI score was significantly higher in nonsurvivors compared to survivors (33.2 ± 7.1 vs. 17.54 ± 6.4, P < 0.001). Receiver operating characteristic curve analysis identified an MPI cut-off value of >26 as optimal for mortality prediction, with sensitivity of 88.9%, specificity of 95.7%, and accuracy of 95.1% (AUC = 0.94). Higher MPI scores were also significantly associated with increased postoperative complications (32.4%) and prolonged hospital stay.

Conclusion:

The MPI is a simple, reliable, and highly accurate prognostic tool for predicting mortality and morbidity in secondary peritonitis. An MPI score >26 represents a critical threshold indicating significantly increased mortality risk and may assist clinicians in postoperative management, risk stratification, and resource allocation.

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