Preoperative serum creatinine as a predictor of survival in perforated gastroduodenal ulcer

Factors affecting survival were retrospectively analyzed in 89 patients (50 men) operated upon for perforated peptic ulcer. Mean age was 52 years. Only 18 per cent had no history of significant medical illness; almost 26 per cent were termed immune suppressed from high-dose steroid therapy or the presence of diffuse, metastatic cancer. The estimated interval between perforation and operation was over 24 hours in one-third. Preoperative serum creatinine, determined in 83 patients, ranged from 0.1 to 6.4 mg/dl (mean, 1.5 mg/dl); no patients were dialysis-dependent. At celiotomy, 75 per cent underwent ulcer plication only; the remainder had a definitive acid reduction procedure. Stepwise logistic regression analysis revealed that a normal preoperative serum creatinine (less than 1.5 mg/dl) was the most powerful predictor of survival (P less than 0.00001), followed by absence of immune suppression, and age under 60 years. The interval between perforation and operation, the site of perforation, and the type of operation did not statistically affect survival.