Prognostic Value of the Mannheim Peritonitis Index in Predicting Mortality Following Emergency Surgery for Hollow Viscus Perforation

Abstract

Introduction: Perforation peritonitis is a life-threatening emergency associated with high morbidity and mortality. Early risk stratification is vital, particularly in resource-limited settings. The Mannheim peritonitis index (MPI) is a widely used prognostic tool, but its performance in Vietnamese patients remains underexplored. The objective of this study was to evaluate the prognostic accuracy of MPI in predicting inhospital mortality among patients undergoing surgery for secondary peritonitis due to hollow viscus perforation. Methods: This prospective observational study included 176 patients treated at a tertiary care center in southern Vietnam from April 2023 to May 2024. Clinical data were collected to calculate MPI scores. Mortality outcomes were analyzed using the receiver-operating characteristic curve and multivariate logistic regression. Results: The mean patient age was 64.9 ± 15.7 years; 70.5% were male. Generalized peritonitis occurred in 96%, and feculent contamination in 5.1%. The most frequent perforation sites were the stomach (43.8%) and duodenum (21%). Overall mortality was 21%. MPI demonstrated excellent predictive performance (area under the curve = 0.944; 95% confidence interval: 0.905–0.988; P < 0.001). An MPI score ≥25 yielded 91.9% sensitivity and 79.9% specificity. Feculent peritonitis (odds ratio [OR] =26.5; P = 0.020) and preoperative organ failure (OR = 51.4; P < 0.001) were independent mortality predictors. Conclusion: MPI is a reliable and efficient tool for early mortality prediction in secondary peritonitis. A threshold score ≥25 effectively identifies high-risk patients and should be integrated into clinical decision-making in emergency surgical settings.