The Mannheim Peritonitis Index (MPI) can be used to predict outcome in patients with severe peritonitis. It is intended to be simple, without need for extensive laboratory data.
Parameters:
(1) age of patient
(2) gender
(3) organ failure(s)
(4) presence of malignancy
(5) preoperative peritonitis for more than 24 hours
(6) diffuse generalized peritonitis
(7) site of primary focus
(8) nature of peritoneal exudative fluid
|
Parameter |
Finding |
Points |
|---|---|---|
|
age in years |
> 50 |
5 |
|
|
<= 50 |
0 |
|
gender |
female |
5 |
|
|
male |
0 |
|
organ failure (see below) |
present |
7 |
|
|
absent |
0 |
|
non-related malignancy |
present |
4 |
|
|
absent |
0 |
|
preoperative peritonitis for more than 24 hours |
present |
4 |
|
|
absent |
0 |
|
primary focus |
not in colon |
4 |
|
|
in colon |
0 |
|
diffuse generalized peritonitis |
present |
6 |
|
|
absent |
0 |
|
exudate |
clear |
0 |
|
|
viscous |
6 |
|
|
fecal |
12 |
|
Organ Failure |
Findings |
|
kidney |
creatinine level >= 177 µmol/L |
|
|
urea level >= 16.7 mmol/L |
|
|
oliguria < 20 mL/h |
|
lung |
PaO2 < 50 mm Hg |
|
|
PaCO2 > 50 mm Hg |
|
shock (according to the definition of Shoemaker) |
hypodynamic |
|
|
hyperdynamic |
|
intestinal obstruction |
paralysis >= 24 hours |
|
|
complete mechanical ileus |
where
• Billing et al have urea nitrogen at 167 mmol/L rather than 16.7; this converts to a BUN of 467 mg/dL. Bosscha et al use a urea nitrogen of 25 mg/dL.
Mannheim peritonitis index =
= SUM(points of parameters present)
Interpretation:
• minimum score: 0
• maximum score: 47
• An MPI > 26 indicates that a very high mortality rate may be expected.
In the series reported by Billing et al,
mortality rate in percent =
= (0.065 * ((MPI) ^ 2)) - (0.38 * (MPI)) - 2.97
Limitations:
• van Laarhoven et al felt that the MPI did not allow prediction of prognosis for the individual patient but rather was more useful to study populations of patients with peritonitis.
Purpose: To use the Mannheim Peritonitis Index (MPI) to predict outcome in a patient with severe peritonitis.
Specialty: Infectious Diseases, Surgery, general, Gastroenterology
Objective: risk factors, severity, prognosis, stage, selection
ICD-10: K65,
