Abstract
BackgroundPatients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Mortality ranges from 3-40% and several prognostic scoring systems have been suggested. The aim of this study was to review the available scoring systems for PPU patients, and to assert if there is evidence to prefer one to the other.Material and methodsWe searched PubMed for the mesh terms “perforated peptic ulcer”, “scoring systems”, “risk factors”, ”outcome prediction”, “mortality”, ”morbidity” and the combinations of these terms. In addition to relevant scores introduced in the past (e.g. Boey score), we included recent studies published between January 2000 and December 2012) that reported on scoring systems for prediction of morbidity and mortality in PPU patients.ResultsA total of ten different scoring systems used to predict outcome in PPU patients were identified; the Boey score, the Hacettepe score, the Jabalpur score the peptic ulcer perforation (PULP) score, the ASA score, the Charlson comorbidity index, the sepsis score, the Mannheim Peritonitis Index (MPI), the Acute physiology and chronic health evaluation II (APACHE II), the simplified acute physiology score II (SAPS II), the Mortality probability models II (MPM II), the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity physical sub-score (POSSUM-phys score). Only four of the scores were specifically constructed for PPU patients. In five studies the accuracy of outcome prediction of different scoring systems was evaluated by receiver operating characteristics curve (ROC) analysis, and the corresponding area under the curve (AUC) among studies compared. Considerable variation in performance both between different scores and between different studies was found, with the lowest and highest AUC reported between 0.63 and 0.98, respectively.ConclusionWhile the Boey score and the ASA score are most commonly used to predict outcome for PPU patients, considerable variations in accuracy for outcome prediction were shown. Other scoring systems are hampered by a lack of validation or by their complexity that precludes routine clinical use. While the PULP score seems promising it needs external validation before widespread use.
Highlights
Peptic ulcer disease is associated with potentially lifethreatening complications, including bleeding, perforation, penetration and obstruction
The aim of this study was to review the available scoring systems used for outcome prediction in peptic ulcer (PPU) patients, and to evaluate if any scoring system has advantages and predictive power to be preferred in clinical practice on this group of patients
Comparison of various scoring systems for outcome prediction was done by receiver operating characteristics curve (ROC)-analyses with reporting on the area under the curve (AUC) [10,16,18,19,22]
Summary
Peptic ulcer disease is associated with potentially lifethreatening complications, including bleeding, perforation, penetration and obstruction. While the clinical picture of patients with perforated peptic ulcer (PPU) sometimes can be blurred by vague symptoms, most PPU patients present with overt symptoms and signs of peritonitis and eventually sepsis. The aim of this study was to review the available scoring systems used for outcome prediction in PPU patients, and to evaluate if any scoring system has advantages and predictive power to be preferred in clinical practice on this group of patients. Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. The aim of this study was to review the available scoring systems for PPU patients, and to assert if there is evidence to prefer one to the other
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