Abstract
IntroductionThe mortality rate of perforated peptic ulcer is still high particularly for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients. This study’s aim was to develop an easy and applicable scoring system to predict mortality based on hospital admission data.MethodsTotal 227 patients operated for perforated peptic ulcer in two centers were included. All data that may be potential predictors with respect to hospital mortality were retrospectively analyzed.ResultsThe mortality and morbidity rates were 10.1% and 24.2%, respectively. Multivariated analysis pointed out three parameters corresponding 1 point for each which were age >65 years, albumin ≤1,5 g/dl and BUN >45 mg/dl. Its prediction rate was high with 0,931 (95% CI, 0,890 to 0,961) value of AUC. The hospital mortality rates for none, one, two and three positive results were zero, 7.1%, 34.4% and 88.9%, respectively.ConclusionBecause the new system consists only age and routinely measured two simple laboratory tests (albumin and BUN), its application is easy and prediction power is satisfactory. Verification of this new scoring system is required by large scale multicenter studies.
Highlights
The mortality rate of perforated peptic ulcer is still high for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients
Perforation was the cause of death in 70% of the patients with peptic ulcer and rate of mortality due to PPU is 10-fold higher than other acute abdominal factors such as acute appendicitis and acute cholecystitis [7]
Peptic Ulcer Perforation Score (PULP) score appears to have the greatest predictability of mortality it is impractical with its complexity [5]
Summary
The mortality rate of perforated peptic ulcer is still high for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients. Perforation was the cause of death in 70% of the patients with peptic ulcer and rate of mortality due to PPU is 10-fold higher than other acute abdominal factors such as acute appendicitis and acute cholecystitis [7]. Some scoring systems such as Boey, Peptic Ulcer Perforation Score (PULP) and ASA (American Society of Anesthesiologists) have been already developed for prediction of mortality at PPU [5,8,9]. Detection of patients with high risk for mortality after PPU surgery can allow other treatment modalities except surgery or can necessitate some extra care protocols to decrease the mortality [6]
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