title: Re-evaluation of Mannheim prognostic index in perforative peritonitis: prognostic role of advanced age. A prospective cohort study.
abstract: BACKGROUND
  Peritonitis from perforation of abdominal viscera is associated with high mortality. In western countries individuals older than 65 years constitute a significant proportion of the population and intra abdominal infections are more challenging to manage in these aged patients.
  
  
  METHODS
  This prospective cohort study included 143 consecutive patients operated on for primary perforative peritonitis. The aim of the study was to assess the prognostic efficacy of Mannheim Peritonitis Index (MPI) in a population with a significant proportion of older patients and to substantiate advanced age as an independent prognostic factor. Patients' informations were collected both on hospitalization and after surgical exploration; severity of peritonitis was evaluated using the MPI. The prognostic value of MPI was compared to older age and other clinical variables.
  
  
  RESULTS
  The intra-hospital mortality was 25.2%. According to the MPI score, the ROC curve identified 21 as cut-off value with a sensitivity of 86% and a specificity of 59% in predicting the risk of death. MPI score and age over 80 years old resulted independent predictors of mortality at multivariate analysis. In the subgroup of patients with MPI score≥21, the mortality rate was 46.4% for patients older than 80 years old and 38.3% for younger patients (p=0.07); in patients with MPI score<21, the mortality of those aged more than 80 years reached 33.3% compared to 3.4% for younger patients (p=0.001).
  
  
  CONCLUSIONS
  Age older than 80 years is strongly related to major increase in mortality rates and should be taken into account together with the MPI score in planning the surgical approach and the post-operative care.
authors.affiliation: Unit of General Surgery and Surgical Oncology - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy. Electronic address: neria@unisi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Neri
authors.affiliation: Unit of General Surgery and Surgical Oncology - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Unit of General Surgery and Surgical Oncology - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Scheiterle
authors.affiliation: Unit of General Surgery and Surgical Oncology - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Di Mare
authors.affiliation: Unit of General Surgery and Surgical Oncology - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Sforza
authors.affiliation: Unit of General and Minimally Invasive Surgery - University Hospital of Siena, Italy; Oncology Department of the University Hospital of Siena, Italy; Department of Medicine, Surgery and Neurosciences - University of Siena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010537:Peritoneum / Q000293:injuries; D010538:Peritonitis / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Aged 80 and over; Cohort study; Intestinal perforation; Peritonitis; Surgery; Treatment outcome