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The Value of Mannheim Peritonitis Index Combined With ASA Classification in Predicting Postoperative Mortality of
Xueqian Ma1, Haojie Wang1, Wuchao Liu1
1Department of Emergency Medicine, The First Affiliated Hospital of, Naval Medical University, Shanghai, China.
Objective:
To explore the value of Mannheim Peritonitis Index (MPI) combined with ASA Classification in predicting mortality of patients with digestive tract perforation (DTP) who underwent surgical treatment.
Methods:
A retrospective analysis was conducted on the clinical data of 248 patients with secondary abdominal infection caused by DTP, who were admitted to the Department of Emergency Surgery, The First Affiliated Hospital of Naval Medical University from August 2021 to August 2025. The patients were divided into the mortality group (n = 41) and the non-mortality group (n = 207). Univariate and multivariate analyses were performed to identify the risk factors for mortality in DTP patients. Receiver operating characteristic (ROC) curve was used to determine the cut-off values of continuous variables, and to evaluate the predictive value of MPI score combined with ASA Classification.
Results:
The total mortality rate of DTP patients was 16.5%. Univariate regression analysis showed that mortality in DTP patients was significantly associated with age, operative time, perforation site, etiology, septic shock, extent of peritonitis, peritoneal exudate, CRP, PCT, Hb, Alb, SCr, ALT, AST, PT, D-dimer, INR, ASA Classification, and MPI score (all p < 0.05). Multivariate regression analysis and ROC curve analysis indicated that ASA Classification ≥ Grade 4 and MPI score ≥ 27 were potential risk factors for mortality in DTP patients. The area under the ROC curve (AUC) of MPI score combined with ASA Classification was 0.904, which was higher than that of MPI score alone (AUC = 0.790) or ASA Classification alone (AUC = 0.786). For predicting mortality in DTP patients, the combined assessment had a sensitivity of 87.8% and a specificity of 81.6%.
Conclusion:
In the prediction of mortality risk in DTP patients, the combined assessment of MPI score and ASA Classification exhibits better predictive performance compared with the application of MPI score or ASA Classification alone.
Insights
Combining the Mannheim Peritonitis Index (MPI) and ASA Classification improves mortality prediction in patients with digestive tract perforation (DTP). This combined approach offers superior accuracy over using either tool alone for surgical patients.
Area of Science:
- Surgical Gastroenterology
- Critical Care Medicine
- Predictive Analytics in Healthcare
Background:
- Digestive tract perforation (DTP) is a severe condition often leading to secondary abdominal infection and increased mortality.
- Accurate prediction of mortality risk is crucial for timely and effective patient management.
Purpose of the Study:
- To evaluate the combined predictive value of the Mannheim Peritonitis Index (MPI) and the American Society of Anesthesiologists (ASA) Classification for mortality in patients with DTP undergoing surgery.
- To compare the efficacy of the combined assessment against individual scores.
Main Methods:
- Retrospective analysis of 248 DTP patients with secondary abdominal infection.
- Division into mortality (n=41) and non-mortality (n=207) groups.
- Univariate, multivariate regression, and Receiver Operating Characteristic (ROC) curve analyses to identify risk factors and assess predictive performance.
Main Results:
- The overall mortality rate for DTP patients was 16.5%.
- Multivariate analysis identified ASA Classification (≥ Grade 4) and MPI score (≥ 27) as significant risk factors for mortality.
- The combined MPI and ASA Classification demonstrated a higher Area Under the Curve (AUC) of 0.904 compared to MPI alone (0.790) or ASA Classification alone (0.786).
- The combined assessment achieved 87.8% sensitivity and 81.6% specificity for predicting mortality.
Conclusions:
- The combined assessment of MPI score and ASA Classification offers superior predictive performance for mortality risk in DTP patients.
- This integrated approach provides a more accurate and reliable tool for risk stratification compared to individual scoring systems.
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