Abstract
Background: Perforated peptic ulcer (PPU) is one of the most common non-traumatic emergency cases in the emergency unit, and have a high mortality rate, more than 70% in the elderly. Accurate and early identification of high-risk surgical patients with PPU is important for triage and risk stratification. The objective of this study was to evaluate the mortality in patients with operated PPU.Methods: Between January 2015 to December 2016, 50 consecutive patients with PPU who performed laparotomy were studied retrospectively. This study was a diagnostic test to evaluate the validity of PULP (Peptic Ulcer Perforation) score to predict mortality in patient with operated PPU and determine the best cut-off point. Presentation ≥ or < 24 hours, age of 65 years old, the presence of preoperative shock, ASA score, the presence of AIDS or active malignancy, liver failure, concomitant use of steroids and serum creatinine > 14.7 g/dL were evaluated in PULP score.Results: The cut-off point for PULP the score in the present study is > 7, based on the optimal cut-off value, patients could be divided into low-risk patients (a score of < 7 points), and high-risk patients (a score of > 7 points). PULP score had 91.7% sensitivity, 65.4% specificity, and 78% accuracy in this study. Positive predictive value and negative predictive the values were 71% and 89.9%.Conclusion: The PULP score is sensitive to predict the mortality risk in patients operated for perforated peptic ulcer and can assist in risk stratification and triage.
Highlights
A perforated peptic ulcer is the most frequent indication for emergency laparotomy and often related to potentially life-threatening complications
Perforation alone is the cause of death in 70% of patients with peptic ulcer and mortality rate is 10-fold higher compared to other acute abdomen diseases such as appendicitis and acute cholecystitis.[2,3,4]
Møller et al had introduced for the first time, which called The PULP scoring system (Peptic Ulcer Perforation)
Summary
A perforated peptic ulcer is the most frequent indication for emergency laparotomy and often related to potentially life-threatening complications. Møller et al had introduced for the first time, which called The PULP scoring system (Peptic Ulcer Perforation). It aimed at predicting mortality in patients with operated peptic ulcer perforation.[6,7]. The objective of this study was to evaluate the mortality in patients with operated PPU. This study was a diagnostic test to evaluate the validity of PULP (Peptic Ulcer Perforation) score to predict mortality in patient with operated PPU and determine the best cut-off point. Conclusion: The PULP score is sensitive to predict the mortality risk in patients operated for perforated peptic ulcer and can assist in risk stratification and triage
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