Year: 2026 | Month: April-June | Volume: 11 | Issue: 2 | Pages: 213-222
DOI: https://doi.org/10.52403/ijshr.20260226
Comparative Evaluation of Mannheim Peritonitis Index and APACHE II Scores in Hollow Viscus Perforation Peritonitis: A Single-Centre Retrospective Study
K N Vijay Kumar1, Manjunath H R2, Lakshmi Narayan3, Kalavathi L4, Ruchitha R Ligade5
1,5Post Graduate Resident, 2,3Professor, 4Assistant Professor, Department of General Surgery, SIMSRC, Chikkabanavara, Bangalore – 560 090, Karnataka, India.
Corresponding Author:Dr. K N Vijay Kumar
ABSTRACT
Background: Hollow viscus perforation peritonitis remains a life-threatening surgical emergency with high morbidity and mortality. Objective scoring at the time of surgery is essential to guide decision-making and resource allocation. The Mannheim Peritonitis Index (MPI) and APACHE II are two widely used multi-parameter scoring systems; however, comparative data from the Indian subcontinent are limited.
Objectives: To evaluate and compare the performance of MPI and APACHE II scores in relation to in-hospital mortality and postoperative outcomes in surgically managed cases of hollow viscus perforation peritonitis.
Materials and Methods: A retrospective observational study of 45 consecutive patients of hollow viscus perforation peritonitis managed by emergency laparotomy at the Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Bangalore, were analysed. MPI and APACHE II scores were computed from clinical, operative, and laboratory data. Statistical analysis was performed using IBM SPSS Statistics version 25.0.
Results: Of the 45 case records analysed (33 males, 12 females; mean age 46.4 ± 20.1 years), 7 (15.6%) had a fatal outcome. The mean MPI was 25.51 ± 8.81 and mean APACHE II was 11.16 ± 9.00. Both scores were significantly higher in non-survivors (MPI: 36.57 ± 3.69 vs. 23.47 ± 7.91, p = 0.0005; APACHE II: 24.14 ± 6.57 vs. 8.76 ± 7.19, p = 0.0003). All deaths occurred in MPI Category C (p = 0.001, Fisher's Exact Test). The AUROC was 0.919 (95% CI: 0.817–0.990) for MPI and 0.936 (95% CI: 0.842–1.000) for APACHE II, with no significant difference (p = 0.755). Both scores correlated significantly with ICU stay duration (MPI: r = 0.703, p < 0.001; APACHE II: r = 0.556, p < 0.001).
Conclusion: Both MPI and APACHE II demonstrated good discriminatory ability and comparable prognostic performance in predicting in-hospital mortality and morbidity in hollow viscus perforation peritonitis. MPI offers practical intraoperative applicability without requiring laboratory data. Larger prospective multicentre studies are required to validate these findings and establish generalisability.
Keywords: Hollow viscus perforation, Peritonitis, Mannheim Peritonitis Index, APACHE II, Prognostic scoring, Mortality, ROC curve