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Preoperative predictors of mortality in intestinal perforation
Fırat Canlıkarakaya1, Serhat Ocaklı2, İbrahim Doğan3
1Amasya University, Faculty of Medicine, Department of General Surgery, Amasya, Türkiye.
Biomolecules & Biomedicine
|October 31, 2025
Summary
The albumin/creatinine ratio, patient age, and serum albumin levels effectively predict mortality in bowel perforation cases. A history of COVID-19 increases the risk of perforation due to ischemia.
Area of Science:
- General Surgical Pathology
- Clinical Biochemistry
Background:
- Bowel perforation is a common, life-threatening surgical emergency.
- Identifying predictors of mortality is crucial for patient management.
Purpose of the Study:
- To evaluate clinical and biochemical parameters for predicting mortality in bowel perforation.
- To assess the impact of COVID-19 history on perforation etiology and outcomes.
Main Methods:
- Retrospective analysis of 144 patients undergoing surgery for bowel perforation (2019-2024).
- Assessment of albumin/creatinine ratio, age, serum albumin, CRP, and COVID-19 history.
- Statistical analysis using logistic regression and receiver operating characteristic (ROC) analysis.
Main Results:
- Overall mortality rate was 25%.
- Independent predictors of mortality: albumin/creatinine ratio <3.38 (OR: 12.666), age >66 years (OR: 3.273), serum albumin <3 g/dL (OR: 5.653).
- Albumin/creatinine ratio showed the highest predictive accuracy (AUC: 0.879).
- COVID-19 history linked to higher ischemia-related perforation (87.5%) vs. malignancy (41.4%) in non-COVID-19 patients (p<0.001).
Conclusions:
- Albumin/creatinine ratio, age, and serum albumin levels are robust mortality predictors in bowel perforation.
- COVID-19 history significantly elevates the risk of ischemic bowel perforation.
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