Skip to main content
Top
Published in: World Journal of Emergency Surgery 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Ebru Menekse, Belma Kocer, Ramazan Topcu, Aydemir Olmez, Mesut Tez, Cuneyt Kayaalp

Published in: World Journal of Emergency Surgery | Issue 1/2015

Login to get access

Abstract

Introduction

The 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.

Methods

Total 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.

Results

The 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.

Conclusion

Because 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.
Literature
1.
go back to reference Lee CW, Sarosi Jr GA. Emergency ulcer surgery. Surg Clin North Am. 2011;91:1001–13. doi:10.1016/j.suc.2011.06.008.CrossRefPubMed Lee CW, Sarosi Jr GA. Emergency ulcer surgery. Surg Clin North Am. 2011;91:1001–13. doi:10.1016/j.suc.2011.06.008.CrossRefPubMed
2.
go back to reference Sarosi Jr GA, Jaiswal KR, Nwariaku FE, Asolati M, Fleming JB, Anthony T. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190:775–9.CrossRefPubMed Sarosi Jr GA, Jaiswal KR, Nwariaku FE, Asolati M, Fleming JB, Anthony T. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190:775–9.CrossRefPubMed
3.
go back to reference Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102–13. doi:10.1159/000323958.CrossRefPubMed Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102–13. doi:10.1159/000323958.CrossRefPubMed
4.
go back to reference Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26–35. doi:10.5230/jgc.2012.12.1.26.CrossRefPubMedCentralPubMed Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26–35. doi:10.5230/jgc.2012.12.1.26.CrossRefPubMedCentralPubMed
5.
go back to reference Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56:655–62. doi:10.1111/j.1399-6576.2011.02609.x.CrossRefPubMed Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56:655–62. doi:10.1111/j.1399-6576.2011.02609.x.CrossRefPubMed
6.
go back to reference Møller MH, Adamsen S, Thomsen RW, Møller AM. Peptic Ulcer Perforation (PULP) trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98:802–10. doi:10.1002/bjs.7429.CrossRefPubMed Møller MH, Adamsen S, Thomsen RW, Møller AM. Peptic Ulcer Perforation (PULP) trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98:802–10. doi:10.1002/bjs.7429.CrossRefPubMed
7.
go back to reference Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101:e51–64. doi:10.1002/bjs.9368.CrossRefPubMed Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101:e51–64. doi:10.1002/bjs.9368.CrossRefPubMed
8.
go back to reference Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22–6.CrossRefPubMedCentralPubMed Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22–6.CrossRefPubMedCentralPubMed
9.
go back to reference Mäkelä JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg. 2002;168:446–51.CrossRefPubMed Mäkelä JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg. 2002;168:446–51.CrossRefPubMed
10.
go back to reference Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013;21:25. doi:10.1186/1757-7241-21-25.CrossRefPubMedCentralPubMed Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013;21:25. doi:10.1186/1757-7241-21-25.CrossRefPubMedCentralPubMed
11.
go back to reference Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg. 2014;18:1261–8. doi:10.1007/s11605-014-2485-5.CrossRefPubMed Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg. 2014;18:1261–8. doi:10.1007/s11605-014-2485-5.CrossRefPubMed
12.
go back to reference Mishra A, Sharma D, Raina VK. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol. 2003;22:49–53.PubMed Mishra A, Sharma D, Raina VK. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol. 2003;22:49–53.PubMed
14.
go back to reference Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22:565–70.CrossRefPubMed Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22:565–70.CrossRefPubMed
15.
go back to reference Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33:80–5. doi:10.1007/s00268-008-9796-1.CrossRefPubMed Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33:80–5. doi:10.1007/s00268-008-9796-1.CrossRefPubMed
16.
go back to reference Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19:347–54. doi:10.3748/wjg.v19.i3.347.CrossRefPubMedCentralPubMed Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19:347–54. doi:10.3748/wjg.v19.i3.347.CrossRefPubMedCentralPubMed
17.
go back to reference Kujath P, Schwandner O, Bruch HP. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg. 2002;387:298–302.CrossRefPubMed Kujath P, Schwandner O, Bruch HP. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg. 2002;387:298–302.CrossRefPubMed
18.
go back to reference Hermansson M, Staël Von Holstein C, Zilling T. Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors. Scand J Gastroenterol. 1997;32:523–9.CrossRefPubMed Hermansson M, Staël Von Holstein C, Zilling T. Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors. Scand J Gastroenterol. 1997;32:523–9.CrossRefPubMed
19.
go back to reference Di Saverio S, Bassi M, Smerieri N, Masetti M, Ferrara F, Fabbri C, et al. Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg. 2014;9:45. doi:10.1186/1749-7922-9-45.CrossRefPubMedCentralPubMed Di Saverio S, Bassi M, Smerieri N, Masetti M, Ferrara F, Fabbri C, et al. Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg. 2014;9:45. doi:10.1186/1749-7922-9-45.CrossRefPubMedCentralPubMed
20.
go back to reference Uchino S, Bellomo R, Goldsmith D. The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury. Clin Kidney J. 2012;5:187–91. doi:10.1093/ckj/sfs013.CrossRef Uchino S, Bellomo R, Goldsmith D. The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury. Clin Kidney J. 2012;5:187–91. doi:10.1093/ckj/sfs013.CrossRef
21.
go back to reference Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491–507.CrossRefPubMedCentralPubMed Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491–507.CrossRefPubMedCentralPubMed
22.
go back to reference Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol. 2010;45:785–805. doi:10.3109/00365521003783320.CrossRefPubMed Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol. 2010;45:785–805. doi:10.3109/00365521003783320.CrossRefPubMed
23.
go back to reference Ñamendys-Silva SA, González-Herrera MO, Texcocano-Becerra J, Herrera-Gómez A. Hypoalbuminemia in critically ill patients with cancer: incidence and mortality. Am J Hosp Palliat Care. 2011;28:253–7. doi:10.1177/1049909110384841.CrossRefPubMed Ñamendys-Silva SA, González-Herrera MO, Texcocano-Becerra J, Herrera-Gómez A. Hypoalbuminemia in critically ill patients with cancer: incidence and mortality. Am J Hosp Palliat Care. 2011;28:253–7. doi:10.1177/1049909110384841.CrossRefPubMed
24.
go back to reference Buck DL, Vester-Andersen M, Møller MH. Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study. Scand J Gastroenterol. 2012;47:28–35. doi:10.3109/00365521.2011.639078.CrossRefPubMed Buck DL, Vester-Andersen M, Møller MH. Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study. Scand J Gastroenterol. 2012;47:28–35. doi:10.3109/00365521.2011.639078.CrossRefPubMed
25.
go back to reference Owens WD. American Society of Anesthesiologists Physical Status Classification System in not a risk classification system. Anesthesiology. 2001;94:378.CrossRefPubMed Owens WD. American Society of Anesthesiologists Physical Status Classification System in not a risk classification system. Anesthesiology. 2001;94:378.CrossRefPubMed
26.
Metadata
Title
A practical scoring system to predict mortality in patients with perforated peptic ulcer
Authors
Ebru Menekse
Belma Kocer
Ramazan Topcu
Aydemir Olmez
Mesut Tez
Cuneyt Kayaalp
Publication date
01-12-2015
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2015
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-015-0008-7

Other articles of this Issue 1/2015

World Journal of Emergency Surgery 1/2015 Go to the issue