Comparative evaluation of Mannheim Peritonitis Index and Mansoura Scoring System for risk stratification in perforation peritonitis: a prospective study from a resource-limited setting of North India

Perforation peritonitis is one of the most common surgical emergencies encountered in clinical practice and is associated with considerable morbidity and mortality. Prognostic scoring systems are important for predicting outcomes, guiding management strategies and facilitating surgical audits. The Mannheim Peritonitis Index (MPI) is a widely used intraoperative scoring system, while the Mansoura Scoring System (MSS) is a newer model based on preoperative inflammatory parameters. The aim of this study was to evaluate the efficacy of MPI and MSS in predicting mortality and postoperative complications in patients with perforation peritonitis. A prospective observational cohort study was conducted in the Department of Surgery at Jawaharlal Nehru Medical College, Aligarh Muslim University. A total of 200 patients diagnosed with perforation peritonitis and undergoing surgical intervention were included. MPI and MSS scores were calculated for all patients. Patients were followed up for 30 days postoperatively to evaluate outcomes including mortality, postoperative complications and hospital stay. Statistical analysis was performed using SPSS version 29. Diagnostic performance of the scoring systems was evaluated using Receiver Operating Characteristic (ROC) curve analysis. The mean age of patients ranged widely, with the highest proportion belonging to the 31–40 year age group. Males constituted 69.5% of the study population. The ileum was the most common site of perforation (56.5%), followed by gastric perforation (15%). Higher MPI and MSS scores were significantly associated with increased postoperative morbidity and mortality. MPI demonstrated higher specificity in predicting mortality, whereas MSS showed comparable sensitivity and allowed earlier preoperative risk assessment. Both MPI and MSS are effective prognostic tools for predicting outcomes in perforation peritonitis. While MPI has a better discriminatory ability for predicting mortality due to its incorporation of intraoperative findings, MSS offers the advantage of early preoperative risk stratification using simple laboratory parameters.