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Evaluation of clinical factors and three scoring systems for predicting mortality in perforated peptic ulcer
M Iqbal Rivai1,2, Avit Suchitra1,2, Aulia Janer2
1Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Andalas University - M.Djamil General Hospital, West Sumatera, 25171, Indonesia.
Background/Objective:
Early identification of mortality risk in perforated peptic ulcer (PPU) patients is important for triage and risk stratification. This study aimed to compare clinical and laboratory factors and three scoring systems to predict mortality in PPU patients.
Methods:
Retrospective data on PPU patients at M. Djamil Hospital who underwent emergency laparotomy repair surgery were collected from December 2018 to May 2021. The data included demographics, clinical characteristics, and three scoring systems. Data analysis used bivariate, multivariate, and ROC analysis.
Results:
A total 72 patients were included and mortality rate was 52.8%. Bivariate analysis showed a significant association between age (p = 0.029), onset of illness (p = 0.001), alteration of consciousness (p = <0.001), respiratory rate (p = 0.04), duration of surgery (p = 0.040), preoperative shock (p = 0.049), preoperative creatinine (p = <0.001), Boey's scores (p = 0.002), ASA (p = 0.001), and qSOFA scores (p = <0.001) with mortality in PPU patients. From multivariate analysis, the strongest clinical factors associated with mortality were alteration of consciousness (p = <0.001) and preoperative creatinine (p = 0.001). Receiver Operating Characteristic (ROC) analysis showed the area under the curve (AUC) of Boey's Score 0.73, ASA classification 0.69, qSOFA score 0.77, alteration of consciousness 0.74, and preoperative creatinine 0.78.
Conclusion:
Preoperative creatinine and altered consciousness had the strongest association with mortality in PPU patients. The qSOFA score predicted mortality better than Boey's score and ASA classification. Preoperative creatinine was the best single predictor of mortality.
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