What Is the Best Predictor of Mortality in Perforated Peptic Ulcer Disease? A Population-Based, Multivariable Regression Analysis Including Three Clinical Scoring Systems

Abstract

BackgroundMortality rates in perforated peptic ulcer (PPU) have remained unchanged. The aim of this study was to compare known clinical factors and three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) in the ability to predict mortality in PPU.Material and MethodsThis is a consecutive, observational cohort study of patients surgically treated for perforated peptic ulcer over a decade (January 2001 through December 2010). Primary outcome was 30-day mortality.ResultsA total of 172 patients were included, of whom 28 (16 %) died within 30 days. Among the factors associated with mortality, the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had an OR of 5.0 and an AUC of 0.75. Hypoalbuminaemia alone (≤37 g/l) achieved an OR of 8.7 and an AUC of 0.78. In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of >24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89.ConclusionSix clinical factors predicted 30-day mortality better than available risk scores. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.Electronic supplementary materialThe online version of this article (doi:10.1007/s11605-014-2485-5) contains supplementary material, which is available to authorized users.

Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring

“…65 Kenneth Thorsen et al stated that combination of six factors of age, active cancer ,hyperbilirubinaemia, hypoalbuminemia, elevated creatinine, and delay of surgery beyond 24 hours added to mortality. 66 Our study reaffirmed the accuracy of Boey's, scoring system in predicting mortality rate 0%,7.1%, 36.4% and 40% for Boey's, score of 0,1,2,3 respectively with (p value 0.011) and morbidity was 10%, 42.9%, 63.6% and 80% with Boey's, Score of 0,1,2,3 respectively with (p value 0.003). A retrospective study by Varut Lohsiriwat et al showed mortality rate was 1%,8%,33%and 38% respectively for Boey's score of 0,1,2 and 3 respectively (p value<0.001) and morbidity rates was 11%,47%,75%,77% for Boey's score of 0,1,2 and 3 respectively (p value <0.001).…”

Emergent Operation for Perforated Peptic Ulcer Disease – Analysis of the ACS-NSQIP Database from 2005 to 2013

“…Infections after operations also contributed significantly to mortality including septic shock, pneumonia and surgical site infections. Risk factors for mortality previously reported in the literature for this population include advanced age, hypoalbuminemia, hyperbilirubinemia, elevated creatinine, active malignancy, delay to surgery and ASA classification 1,2,28,23 . analyses may compare other risk factors with race such as comorbidities and the incidence of postoperative complications.…”

Acute Perforated Peptic Ulcer : A Clinical, Diagnostic and Management Analysis in a Tertiary Hospital of Telangana

“…32 Hypoalbuminemia alone is also a risk factor of raised morbidity or mortality as stated by. 33 Thorsen et al was found that hypoalbuminemia was a strong factor which might determine mortality solely (AUC:0.78). 32 The correlation between hypoalbuminemia and mortality in PULP is due to reduction in synthesis of albumin in patients with dehydration, hepatic dysfunction, cancer, critical clinical course, systemic inflammatory response syndrome and sepsis.…”