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. 2019 May 10:42:23-28.
doi: 10.1016/j.amsu.2019.05.001. eCollection 2019 Jun.

Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study

Tamer Saafan  1 , Walid El Ansari  2   3   4 , Omer Al-Yahri  1 , Ammar Eleter  1 , Hisham Eljohary  1 , Rashad Alfkey  1 , Mustafa Hajjar  1 , Ali Toffaha  1 , Abdelrahman El Osta  5
Affiliations

Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study

Tamer Saafan et al. Ann Med Surg (Lond). .

Abstract

Background: /aim: Scores commonly employed to risk stratify perforated peptic ulcer patients include ASA (American Society of Anesthesiologists), Boey and peptic ulcer perforation score (PULP). However, few studies assessed and compared the accuracy indices of these three scores in predicting post PPU repair 30-day morbidity. We assessed accuracy indices of PULP, and compared them to Boey and ASA in predicting post perforated duodenal (PDU) ulcer repair 30-day morbidity.

Methods: Retrospective chart review of all PDU patients (perforated duodenal ulcers only) at the largest two hospitals in Qatar (N = 152). Data included demographic, clinical, laboratory, operative, and post repair 30-day morbidity. Area under the Curve (AUC), sensitivity and specificity were computed for each of the 3 scores. Multivariate logistic regression assessed the accuracy indices of each score.

Results: All patients were males (M age 37.41 years). Post PDU repair 30-day morbidity was 10.5% (16 morbidities). Older age, higher ASA (≥3), Boey (≥1) or PULP (≥8) scores, shock on admission and preoperative comorbidities; and conversely, lower hemoglobin and albumin were all positively significantly associated with higher post PDU 30-day morbidity. PULP displayed the largest AUC (72%), and was the only score to significantly predict 30-day morbidity. The current study is the first to report the sensitivity and specificity of these three scores for post PDU repair 30-day morbidity; and first to assess accuracy indices for PULP in predicting post PDU repair 30-day morbidity.

Conclusion: PULP score had the largest AUC and was the only score to significantly predict post PDU repair 30-day morbidity.

Keywords: ASA; Boey; M&M, mortality and morbidity; PDU, Perforated peptic ulcer; PPU, perforated peptic ulcer; PULP; PULP, peptic ulcer perforation score; Perforated duodenal ulcer; Perforated peptic ulcer; Perforated peptic ulcer score.

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Figures

Fig. 1
Fig. 1
ROC curves for PULP, Boey and ASA showing the area under the curve.
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References

    1. Kitagawa Y., Dempsey D.T., Stomach . In: Schwartz's Principles of Surgery. Brunicardi F., Andersen D.K., Billiar T.R., Dunn D.L., Hunter J.G., Matthews J.B., Pollock R.E., editors. McGraw-Hill; 10e New York, NY: 2015. http://accesssurgery.mhmedical.com/content.aspx?bookid=980&sectionid=596...
    2. Y. Kitagawa, DT Dempsey, Stomach. In: F Brunicardi, DK Andersen, TR Billiar, DL Dunn, JG Hunter, JB Matthews, RE Pollock. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill. http://accesssurgery.mhmedical.com/content.aspx?bookid=980&sectionid... 17 Sept 2018)
    1. Behrman S.W. Management of complicated peptic ulcer disease. Arch. Surg. 2005;140(2):201–208. - PubMed
    2. S.W. Behrman, Management of complicated peptic ulcer disease, Arch Surg., 140 (2) (2005), pp. 201-208. - PubMed
    1. Søreide K., Thorsen K., Søreide J.A. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br. J. Surg. 2014;101(1):51–64. - PubMed
    2. K. Soreide, K. Thorsen, J.A. Soreide, Strategies to improve the outcome of emergency surgery for perforated peptic ulcer, Br J Surg., 101 (1) (2014), pp. 51-64. - PubMed
    1. Thorsen K., Søreide J.A., Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J. Gastrointest. Surg. 2014;18(7):1261–1268. - PMC - PubMed
    2. K. Thorsen, J.A. Soreide, K. Soreide, What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems, J Gastrointest Surg., 18 (7) (2014), pp. 1261-1268. - PMC - PubMed
    1. Boey J., Choi S.K., Poon A., Alagaratnam T.T. Risk stratification in perforated duodenal ulcers, A prospective validation of predictive factors. Ann. Surg. 1987;205:22–26. - PMC - PubMed
    2. J Boey, S.K. Choi, A. Poon, T.T. Alagaratnam, Risk stratification in perforated duodenal ulcers, A prospective validation of predictive factors, Ann Surg., 205 (1987), pp. 22-26. - PMC - PubMed