IS THE MANNHEIM INDEX STILL USEFUL IN THE PROGNOSIS OF PATIENTS WITH SECONDARY ACUTE PERITONITIS?

  • C.G. FLOREA “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • I.S. COMAN “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • M. LIȚESCU “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • C. BURLEANU
  • Violeta Elena COMAN “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Raluca Maria FLOREA “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania
  • A. ERCHID “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • V.T. GRIGOREAN “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Keywords: PERITONITIS, DIGESTIVE PERFORATION, PEPTIC ULCER, MANNHEIM INDEX

Abstract

Digestive tract perforations or anastomotic dehiscence are the main causes of secondary acute peritonitis, in 80% of cases rapid surgical intervention combined with antibiotic therapy leads to a favorable prognosis. The Mannheim index represents a simple and inexpensive score used in acute peritonitis, which was originally derived from a study on 1253 patients with peritonitis treated between 1963 and 1979. Material and methods: We performed a retrospective study on 185 patients, hospitalized with the diagnosis of acute peritonitis who underwent surgery, in the general surgery clinic of the Emergency Clinical Hospital “Bagdasar-Arseni” Bucharest between 2016 and 2019. The patients were grouped into 4 risk groups according to the Mannheim index as follows: < 12, 12 - 20, 21 - 27, > 27. Results: A value of the Mannheim index below 12 was recorded in 75 patients with a mortality of 8%, values ​​between 12 and 20 were in 59 patients with a mortality of 13.55%, values ​​between 21 and 27 were in 40 patients with a mortality of 25% and a Mannheim index value above 27 were in 11 patients with a mortality of 63.63%. Conclusions: The Mannheim Index may be a useful predictor of progression, and further analysis may be beneficial to explore this relationship further.

Author Biographies

C.G. FLOREA, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Ph.D. Student, Doctoral School 
“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

I.S. COMAN, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Faculty of Medicine Department of Surgery
Faculty of Dentistry, Department of Surgery
“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

M. LIȚESCU, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Faculty of Dentistry, Department of Surgery
“Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania
Department of  General Surgery

C. BURLEANU

“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

Violeta Elena COMAN, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Faculty of Medicine Department of Surgery
“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

Raluca Maria FLOREA, “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania

Department of Gastroenterology

A. ERCHID, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Ph.D. Student, Doctoral School
“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

V.T. GRIGOREAN, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Faculty of Medicine Department of Surgery
“Bagdasar-Arseni” Emergency Clinical Hospital, Bucharest, Romania
Department of General Surgery

References

1. Mulari K, Leppäniemi A. Severe secondary peritonitis following gastrointestinal tract perforation. Scand J Surg 2004; 204-208 / doi: 10.1177/145749690409300306.
2. Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 1994; 81(2): 209-213.
3. McLauchlan GJ, Anderson ID, Grant IS, Fearon KCH. Outcome of patients with abdominal sepsis treated in an intensive care unit. Br J Surg 1995; 82(4): 524-529 / doi: 10.1002/bjs.1800820429
4. Koperna T, Schulz F. Prognosis and Treatment of Peritonitis: Do We Need New Scoring Systems? Arch Surg 1996; 131(2): 180-186 / doi: 10.1001/archsurg.1996.01430140070019
5. Pacelli F, Doglietto GB, Alfieri S, et al. Prognosis in Intra-abdominal Infections: Multivariate Analysis on 604 Patients. Arch Surg 1996; 131(6): 641-645 / doi: 10.1001/ archsurg.1996.01430180067014
6. Ohmann C, Yang Q, Hau T, Wacha H. Prognostic modelling in peritonitis. Peritonitis Study Group of the Surgical Infection Society Europe. Eur J Surg 1997; 163(1): 53-60.
7. Sharma S, Singh S, Makkar N, Kumar A, Sandhu M. Assessment of severity of peritonitis using mannheim peritonitis index. Niger J Surg 2016; 22(2): 118-122.
8. Badiu DC, Bolocan A, Manea CA, et al. Proinflammatory cytokines and Mannheim index in predicting mortality rates in patients with peritonitis caused by perforation. Rom Biotechnol Lett 2017; 22(5): 12979.
9. Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim perito-nitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg 1987; 58(2): 84-92.
10. Qureshi AM, Zafar A, Saeed K, Quddus A. Predictive power of Mannheim peritonitis index. J Coll Physicians Surg Pakistan 2005; 15(11): 693-696.
11. Bracho-Riquelme RL, Melero-Vela A, Torres-Ramírez A. Mannheim peritonitis index validation study at the hospital general de durango (Mexico). Cir Cir 2002; 70(4): 217-225.
12. Rogy M, Függer R, Schemper M, Koss G, Schulz F. The value of 2 distinct prognosis scores in pa-tients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score. Chirurg 1990; 61(4): 297-300.
13. Anaya DA, Nathens AB. Risk factors for severe sepsis in secondary peritonitis. Surg Infect (Larchmt) 2003; 4(4): 355-362.
14. Malangoni MA. Current concepts in peritonitis. Curr Gastroenterol Rep 2003; 5(4): 295-301.
15. Yilmazlar T, Toker S, Zorluoğlu A. Non-traumatic colorectal perforations. Int Surg 1999; 84(2): 155-158.
16. Meena A, Singh R, Sharma M, Bhadoo M, Sethi D. Efficacy of Mannheim Peritonitis Index (MPI) Score in Patients with Perforation Peritonitis in a Tertiary Care Setup. European Journal of Molecular & Clinical Medicine 2022; 9(4): 1778-1784.
17. Ermolov AS, Bagdat’ev VE, Chudotvortseva EV, Rozhnov AV. Evaluation of the Mannheim Perito-nitis Index. Vestn Khir Im II Grek 1996; 155(3): 22233.
18. Bosscha K, Reijnders K, Hulstaert PF, Algra A, van der Werken C. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg 1997; 84(11): 1532-1534.
19. Liverani A, Correnti SF, Paganelli MT, Antonini G, Mercati U. Mannhein index in the prognosis and treatment of acute peritoniti. Minerva Chir 1998; 53(5): 385-389.
20. Sökmen S, Çöker A, Ünek T, Tunçyürek P, Bora S. Effectiveness of Mannheim Peritonitis Index in patients with peritonitis. Ulus Travma Derg 2001; 7(2): 100-103.
21. González-Aguilera JC. Generalized peritonitis prognosis according to Mannheim index. Cir Cir 2002; 70(3): 179-182.
22. Hut’an M, Poticný V, Balaz P. Modern trends in the treatment of diffuse peritonitis. Rozhl v Chir Mesic Ceskoslov Chir Spol 2000; 79(4): 171-174.
23. Malkov IS, RSh S, Zaĭnutdinov AM, Birial’tsev VN, Lustina NI. Laparoscopic sanitation of the ab-dominal cavity in combined treatment of peritonitis. Khirurgiia (Sofiia) 2002; (6): 30-33.
24. Demmel N, Muth G, Maag K, Osterholzer G. Prognosescores bei peritonitis: Mannheim peritonitis-index oder APACHE II ? Langenbecks Arch Chir 1994; 379(6): 347-352 / doi: 10.1007/BF00191581.
25. Kologlu M, Elker D, Altun H, Sayek I. Validation of MPI and PIA II in two different groups of pa-tients with secondary peritonitis. Hepatogastroenterology 2001; 48(37): 147-151.
Published
2023-06-30