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A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score
Aboli Koranne1, K G Byakodi1, Vasant Teggimani1
1Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
Insights
The Mannheim Peritonitis Index (MPI) and Jabalpur Score (JS) accurately predict mortality in perforated peptic ulcer (PPU) cases. The Peptic Ulcer Perforation (PULP) score better predicts postoperative complications.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Public Health
Background:
- Peptic ulcer disease remains a significant public health concern, particularly in developing nations.
- Perforated peptic ulcer (PPU) complications carry a high mortality rate.
- Effective risk stratification is crucial for optimizing patient management and resource allocation.
Purpose of the Study:
- To compare the accuracy of existing scoring systems in predicting mortality for perforated peptic ulcer (PPU) patients.
- To identify the most reliable predictor of mortality and postoperative complications in PPU cases.
Main Methods:
- An observational study involving 45 surgically treated PPU patients from December 2017 to August 2019.
- Collected demographic data and calculated Peptic Ulcer Perforation (PULP) score, Mannheim Peritonitis Index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur Score (JS).
- Compared the predictive accuracy of these scoring systems for mortality and postoperative complications.
Main Results:
- The Mannheim Peritonitis Index (MPI) and Jabalpur Score (JS) demonstrated statistically significant prediction of mortality (p<0.001 and p=0.007, respectively).
- Peptic Ulcer Perforation (PULP) score was a significant predictor of postoperative complications (p=0.047).
- American Society of Anesthesiologists (ASA) and PULP scores were not statistically significant predictors of mortality.
Conclusions:
- The MPI and JS are superior predictors of mortality in perforated peptic ulcer patients within this population.
- The PULP score is a valuable tool for predicting postoperative complications in PPU cases.
Abstract:
Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases. Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period. Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p -value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p -value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p -value of 0.047. Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.
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