Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease
Shaili Patel, Devanshu Kalra, Samir Kacheriwala, Mihir Shah, Dipesh Duttaroy
Department of Surgery, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, India
Abstract
Objective: Perforations in Peptic Ulcer Disease are known to cause considerable morbidity and mortality. The objective of this study was to compare efficacy of known clinical parameters and three existing scoring systems in predicting 30-day mortality and determining mortality risk stratification based on risk factors.
Material and Methods: This was a prospective observational study of 190 patients operated for perforated peptic ulcer over a period of 14 months at a 1500 bed tertiary care university hospital in Western India.
Results: The mortality rate observed was 18.95%. Elderly population, raised serum creatinine, time delay to surgery > 24 hours, preoperative shock and pre-existing medical illness were identified as risk factors for poor postoperative prognosis. The Area under curve for mortality prediction was 0.590 for ASA, 0.745 for Boey and 0.804 for PULP score. Mortality was best anticipated by a combination of raised serum creatinine levels, preoperative shock and delayed surgery by multivariate logistic regression analysis.
Conclusion: Poor outcome was significantly higher in the elderly, patients with raised serum creatinine, preoperative shock, pre-existing medical illness and when the time delay to surgery was > 24 hours. In spite of the Boey score being more practical in application, PULP score proved to be a more precise indicator of mortality. A larger study inclusive of other Mortality Risk Prediction Models would help formulate a more accurate and population specific scoring system.
Keywords: Perforated peptic ulcer, scoring systems, risk factors, 30-day mortality
Cite this article as: Patel S, Kalra D, Kacheriwala S, Shah M, Duttaroy D. Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease. Turk J Surg 2019; 35 (4): 252-258.
Approval of the corporate ethics committee was obtained.
Obtained from all patients.
Externally peer-reviewed.
Concept - All of authors; Design - All of authors; Supervision - S.K., M.S., D.D.; Resource - S.P., D.K., S.K., D.D.; Materials -S.P., D.K.; Data Collection and/or Processing - S.P., D.K.; Analysis and/or Interpretation - S.P., D.K.; Literature Search - S.P., S.K., D.D.; Writing Manuscript - S.P., S.K., D.D.; Critical Reviews - S.K., D.D.
The authors have no conflicts of interest to declare.
The authors declare that they have no potential conflicts of interest.