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Peritonitis Outcome Prediction using Mannheim Perit onitis Index at St. Francis Hospital Nsambya, Kampala - Uganda
Ojuka, A.; Ekwaro, L. & Kakande, I.
Abstract
Background:
A wide variety of disease states give rise to intra-abdominal infection 1.
While
varying according to age, gender and geography, the
three most common causes of
generalized peritonitis in low-income countries are
probably appendicitis, perforated
duodenal ulcer and typhoid perforations, in no particular order 2.The management of
peritonitis for a long time has presented a challenge to surgeons despite different
advancements in the field of medicine. This led to
the development of disease severity
grading systems that would aid in classifying patients by individual risk factors and hence
appropriately predict possible outcome. Mannheim Peritonitis Index (MPI) which was
developed by Wacha and Linder in 1983 is one of the
scoring tools being used to predict
outcome. MPI was used to assess outcome in patients
with peritonitis at Nsambya hospital.
The objective was to predict outcome using the MPI
in patients with peritonitis at Nsambya
Hospital.
Methods:
Retrospective and Prospective evaluation of the MP
I score was performed for
patients with peritonitis who underwent surgical treatment at Nsambya Hospital for 15 months (Jan 2012- march 2013).
Results:
Of the 62 patients included, 29 patients were retrospective and 33 patients
prospective, 46 (74.2%) were males while 16 (25.8%)
were females, giving a male to
female ratio of 3:1. The mean age of presentation was 30.79 (Sd15.55) years, the youngest
being 11 years and the oldest 77 years.
The mean MPI was 21.92±6.02 points with 10 points as the lowest score and 37 points as
the highest score. 58.1% of our patients had an MPI score < 21and 29% MPI 21-29 and
12.9% MPI>29. No death was noted at MPI<21, 2 deaths at MPI 21-29 and 1 death at MPI
>29.
The most significant predictive factors for morbidity/mortality in this study were the
presence of organ failure and female gender. The ROC curve for morbidity showed a
predictive power of 0.875 with a sensitivity of 84.2% and a specificity of 90.7% at MPI of
≥26 points. The predictive power of the MPI for mortality was 0.579 with a sensitivity of
15.8% and a specificity of 100% at MPI score of ≥26
points. The positive predictive value
and negative predictive value for morbidity and mortality at MPI≥26 points were 75.9%,
94.4% and 100%, 95.9% respectively.
Conclusion:
The MPI score is a good tool in predicting morbidity than mortality at Nsambya
hospital and can be used to evaluate outcome in patients with peritonitis.
Keywords
Peritonitis; Prediction; Outcome; Mannheim Peritonitis Index
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