Abstract
BackgroundThe aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU).MethodsAt St. Luke’s International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression.ResultsA total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70–100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13–36.2). The sensitivity analysis showed consistent results, with an OR of 23.8–366.2 for muscular defense and an OR of 3.67–7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03–22.3).ConclusionsThe evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain.
Highlights
The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU)
Four different models were conducted and significant differences were found for muscular defense and peptic ulcer disease (PUD) in all models
The data are as follows for the symptom of muscular defense: logistic step-wise model (odd ratio [odds ratio (OR)]: 366.2, 95% confidence interval (CI): 61.9–2166.2), conditional step-wise model (OR: 76.6, 95% CI: 13.7–429.6), logistic forced-entry model (OR: 28.4, 95% CI: 11.6–69.6), and conditional forced-entry model (OR: 23.8, 95% CI: 5.70–100.0)
Summary
The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU). A perforated peptic ulcer (PPU) is worsened consequence of peptic ulcer disease (PUD), several clinical features and prognoses are dramatically different. One of the reasons is that symptoms of PPU vary over time and are classified into three phases. The first phase appears within 2 h of onset, and symptoms such as acute abdominal pain, tachycardia and peripheral coldness are typical of this stage. Severe pain stimulates sympathetic nerves, and tachycardia and peripheral coldness result. After more than 12 h of onset, patients become hemodynamically unstable, and death may be a consequence [1]. Several clinical features, such as diffuse abdominal pain, muscular defense and a change in symptoms are unique for PPU [2].
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