A practical scoring system to predict mortality in patients with perforated peptic ulcer

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.

Do elevated blood calcium levels in patients with peptic ulcer facilitate perforation?

“…Although studies reporting the effect of calcium on the increase in gastric acidity are intense (2)(3)(4)7,8), other literature reports focus on either increased pepsinogen (3,7) or increased gastrin levels (2,9,10 (12). In contrast, we had no mortalities.…”

Frailty of Boey Score in Ppu Mortality and Morbidity Prediction- A Prospective Study

“…[5] Mean age in Original Boey study was 51 years and omitted advanced age, elderly women population with ulcerogenic medications like Non-steroidal Antiinflammatory Drugs (NSAIDS), sample size from developing countries, prognostic factors like tachycardia (Heart Rate >100 beats/minute), acute renal failure, delay from time of perforation to hospital admission; thus causing extremely variable results in successive studies in literature. [5,6,7] Variability in admission time since onset of symptoms of PPU especially in young alcoholics and consumptions of Aspirin in elderly independently adds to post-operative complication rate of 17-60% independent of Boey score calculated for a given patient. [7,8] Mortality reported in our study for Boey score 2 alone was 27.3% similar to literature reports that range from 30-60%.…”

“…[5,6,7] Variability in admission time since onset of symptoms of PPU especially in young alcoholics and consumptions of Aspirin in elderly independently adds to post-operative complication rate of 17-60% independent of Boey score calculated for a given patient. [7,8] Mortality reported in our study for Boey score 2 alone was 27.3% similar to literature reports that range from 30-60%. [8] Independent studies conducted by Ahmad et al, Nichakankitti et al and Nwashilli exposed Boey score, though easy to calculate and increasing Boey score was associated with high mortality, yet it had poorest ability to predict mortality/morbidity and was non-significant (p>0.05), so prompt diagnosis and succedent stratification of high risk patients may prove beneficial.…”

Evaluation of mortality and morbidity in patients with secondary peritonitis using predictive score of mortality in perforated peptic ulcer

“…"These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given". 2 Total score was between 0-3 and maximum score were 3. The total score was compared with the outcome of the disease in relation with mortality.…”

“…2 This study is aimed to assess the validity of previously derived POMPP score in peptic ulcer perforation by Menekse et al and also to assess its usefulness in other gastrointestinal perforation.…”