A single emergency center study for evaluation of P-POSSUM and Mannheim Peritonitis Index as a risk prediction model in patients with non-traumatic peritonitis

Boram Kim¹

, Seong Hun Kim²

, Sung Pil Michael Choe¹

¹Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
²Department of Emergency Medicine, Ulsan Medical Center, Ulsan, Korea

Correspondence

Jeong Sik Yi ,Tel: 054-450-9936, Fax: 054-450-9967, Email: dallmuli@naver.com,

Received: July 6, 2021; Revised: September 24, 2021 Accepted: September 29, 2021. Published online: April 30, 2022.

ABSTRACT

Objective:
Peritonitis is a life-threatening, emergent surgical disease with very high mortality and morbidity. Currently, there are insufficient Korean studies using the P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and the Mannheim Peritonitis Index (MPI) as risk prediction models for nontraumatic peritonitis patients who visit the emergency room.
Method:
This retrospective study was carried out on 196 cases of non-traumatic peritonitis in a single emergency center from January 2015 to December 2019. Receiver operating characteristic (ROC) curves were obtained and the area under the ROC curve (AUC) was compared using both P-POSSUM and MPI. The observed mortality and expected mortality for P-POSSUM were compared using the goodness of fit assessed using the Hosmer-Lemeshow equation.
Results:
Diastolic blood pressure, blood urea nitrogen, potassium, length of stay, and intensive care unit admissions were significantly different between survivors and non-survivors. The AUC was 0.812 for P-POSSUM and 0.646 for MPI. The observed-to-expected mortality ratio for P-POSSUM indicated fewer than expected deaths in all quintiles of risk and this was more pronounced, especially when the expected mortality was over 60%.
Conclusion:
In non-traumatic peritonitis patients, P-POSSUM was more useful in predicting risk than the MPI score. However, P-POSSUM overestimated the risk in high-risk patients. Although the MPI score is only somewhat useful for predicting mortality in patients with non-traumatic peritonitis, it is useful as an adjuvant.

Key words: Peritonitis; Risk assessment; Mortality