Predicting Outcomes of Patients with Perforation Peritonitis Using the Mannheim Peritonitis Index and Acute Physiology and Chronic Health Evaluation II Scoring Systems

Ganesh T A, Manik Gedam

Abstract: Introduction: Perforation peritonitis is a severe surgical emergency associated with high morbidity and mortality, particularly in developing countries. Early and accurate risk stratification is essential to guide timely surgical intervention, optimize resource allocation, and improve postoperative care. The Mannheim Peritonitis Index and the Acute Physiology and Chronic Health Evaluation II scoring systems are widely utilized to predict outcomes in these critically ill patients. This study aims to prospectively evaluate and compare the predictive accuracy of these two scoring systems specifically in patients presenting with hollow viscus perforation. Methods: This prospective observational study included 50 patients diagnosed with secondary peritonitis who underwent emergency laparotomy at a tertiary healthcare teaching hospital. Patients with primary peritonitis, trauma-related peritonitis, and acute pancreatitis were excluded. Comprehensive clinical, laboratory, and operative data were recorded to calculate the Mannheim Peritonitis Index and Acute Physiology and Chronic Health Evaluation II scores on admission. The primary outcomes assessed were in-hospital mortality and postoperative morbidity, including wound infection and anastomotic leak. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results: The study cohort comprised 38 males (76.0%) and 12 females (24.0%) with a mean age of 43.14 ? 12.83 years. Gastric perforation was the most frequent aetiology, accounting for 18 cases (36.0%). The Mannheim Peritonitis Index, utilizing a cutoff score of 21, demonstrated a sensitivity of 88.89% (8 of 9 non-survivors) and a specificity of 85.37% (35 of 41 survivors) for predicting mortality, yielding an overall diagnostic accuracy of 86.00% (43 of 50 patients). Alternatively, the Acute Physiology and Chronic Health Evaluation II score, at a cutoff of 15, yielded a sensitivity of 77.78% (7 of 9 non-survivors) and a specificity of 97.56% (40 of 41 survivors), achieving a higher overall diagnostic accuracy of 94.00% (47 of 50 patients). Both scoring systems were significantly associated with the incidence of postoperative complications, with higher scores strictly correlating to increased rates of wound infection, wound dehiscence, and the need for re-operation (p < 0.05). Conclusion: Both scoring systems serve as highly reliable predictors of mortality and morbidity in perforation peritonitis. The Mannheim Peritonitis Index is a simple, rapid tool highly effective for mortality prediction in resource-limited settings. Conversely, the Acute Physiology and Chronic Health Evaluation II system provides a more comprehensive physiological assessment and slightly superior discriminative accuracy, making it highly valuable for risk stratification in advanced critical care environments.

Keywords: APACHE II score, Mannheim Peritonitis Index, mortality prediction, perforation peritonitis, postoperative morbidity, surgical emergency

How to Cite?: Ganesh T A, Manik Gedam, "Predicting Outcomes of Patients with Perforation Peritonitis Using the Mannheim Peritonitis Index and Acute Physiology and Chronic Health Evaluation II Scoring Systems", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 607-615, https://www.ijsr.net/getabstract.php?paperid=MR26809135102, DOI: https://dx.doi.org/10.21275/MR26809135102

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