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

Lokesh Kumar, Sunita Singh, Dhirendra Pratap, Krishna K. Singh, Shubham Nayak, Shailendra Kumar, Utkarsh Tripathi


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.


Perforation peritonitis, Scoring tools, MPI, APACHE-II, p-POSSUM, Mortality

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