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East and Central African Journal of Surgery

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Prediction of Outcome Using the Mannheim peritonitis Index in Patients with Peritonitis at Kigali University Teaching Hospital

F Ntirenganya, G Ntakiyiruta, I Kakande

Abstract


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 eritonitis, 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.



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