The Value of Mannheim Peritonitis Index Combined With ASA Classification in Predicting Postoperative Mortality of Patients With Digestive Tract Perforation.

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.