Materiały źródłowe

• #1 Survival in peptic ulcer – PubMed

  https://pubmed.ncbi.nlm.nih.gov/710858/

  The present study of the prognosis in peptic ulcer comprises (1) an analysis of deaths caused by the disease itself, and (2) an independent actuarial analysis of life expectancy. […] The two methods of analysis both showed that peptic ulcer does influence the survival, but the excess of deaths was small and, in the case of solitary peptic ulcer, was present only in the first year or two after the diagnosis. […] The prognosis tended to be more serious in gastric ulcer than in duodenal ulcer, but the difference was not significant. […] In duodenal ulcer the survival tended to be better when only a deformed bulb was present. […] Patients with combined gastric and duodenal ulcers had a fatality twice as great as those with solitary ulcers. […] No excess of deaths was found in patients under the age of 50 years at diagnosis. […] The duration of prediagnostic symptoms was not predictive for the prognosis.

• #2 Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-9-45

  When PPU are diagnosed expeditiously and promptly treated, outcomes are excellent. Mortality ranges from 6% to 14% in recent studies. Poor outcomes have been associated with increasing age, major medical illness, peri-operative hypotension, and delay in diagnosis and management (greater than 24 hours). Advanced age (greater than 70 years) is associated with a higher mortality with rates of approximately 41%. Several scoring systems including the Boey scoring system and the Mannheim Peritonitis Index (MPI) have been used to stratify the risk of the patients and predict the outcomes of patients with perforated peptic ulcer. The Boey score is the most commonly and easily implemented among these scoring systems, and accurately predicts perioperative morbidity and mortality. […] Moller et al. derived the Peptic Ulcer Perforation score (PULP score), a clinical prediction rule for 30-day mortality. The score assesses and compares its prognostic performance with the American Society of Anaesthesiologists (ASA) and Boey scores.

• #3 Temperature, Neutrophils and Multiple Organ Failure Score: A Simple Scoring System to Predict Mortality Following Perforated Peptic Ulcer

  https://www.sgo-iasgo.com/article/temperature,-neutrophils-and-multiple-organ-failure-score-a-simple-scoring-system-to-predict-mortality-following-perforated-peptic-ulcer

  Patients with perforated peptic ulcer (PPU) present with signs of sepsis and appropriate management can be offered to achieve an optimal outcome of disease. […] Many scoring systems (Boey score, Peptic Ulcer Perforated (PULP) Score, American Society of Anaesthesiologists (ASA) score) have been proposed to predict mortality after PPU. […] ASA score and stage were significant independent predictors of post-operative mortality in multivariate analysis. […] PPU carries a mortality ranging from 1.3% to 40%. […] The mortality rate is as high as 12%-47% in elderly patients undergoing PPU surgery. […] Our new scoring system is simple to use and it seems to be a good predictor of mortality. […] We believe that the initial TNM stage can be easily adopted in the clinical practice to predict the surgical mortality of PPU patients.

• #4 Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study | BMJ Open

  https://bmjopen.bmj.com/content/8/8/e023721

  Objectives This study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement. […] Patients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

• #5 Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study | BMJ Open

  https://bmjopen.bmj.com/content/8/8/e023721

  The postoperative in-hospital 60-day mortality rates were 11.7% and 17.8%, respectively. In exploratory analysis, mortality after repair of perforated ulcer was primarily associated with patient factors, rather than potentially modifiable aspects of the care provided. This may make it difficult to reduce mortality rates further.

• #6 Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease – Turkish Journal of Surgery

  https://turkjsurg.com/articles/validation-of-prognostic-scoring-systems-for-predicting-30-day-mortality-in-perforated-peptic-ulcer-disease/doi/turkjsurg.4211

  Objective: Perforations in Peptic Ulcer Disease are known to cause considerable morbidity and mortality. The objective of this study was to compare efficacy of known clinical parameters and three existing scoring systems in predicting 30-day mortality and determining mortality risk stratification based on risk factors. […] The mortality rate observed was 18.95%. Elderly population, raised serum creatinine, time delay to surgery 24 hours, preoperative shock and pre-existing medical illness were identified as risk factors for poor postoperative prognosis. […] Poor outcome was significantly higher in the elderly, patients with raised serum creatinine, preoperative shock, pre-existing medical illness and when the time delay to surgery was 24 hours. […] Logistic regression analysis for pre-operative parameters showed significant association of mortality with raised serum creatinine levels, preoperative shock and delayed surgery.

• #7

  https://link.springer.com/article/10.1007/s11605-014-2485-5

  Mortality rates in perforated peptic ulcer (PPU) have remained unchanged. The aim of this study was to compare known clinical factors and three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) in the ability to predict mortality in PPU. […] A total of 172 patients were included, of whom 28 (16 %) died within 30 days. Among the factors associated with mortality, the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had an OR of 5.0 and an AUC of 0.75. Hypoalbuminaemia alone (37 g/l) achieved an OR of 8.7 and an AUC of 0.78. In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of 24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89.

• #8

  https://link.springer.com/article/10.1007/s11605-014-2485-5

  Six clinical factors predicted 30-day mortality better than available risk scores. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation. […] The combination of age, active cancer, hyperbilirubinaemia, hypoalbuminaemia, elevated creatinine and delay from perforation to surgery of 24 h predicted mortality best. […] Hypoalbuminaemia was strongly associated with increased mortality, and this is in line with previous reports on perforated peptic ulcer. […] The new PULP score and the ASA score predicted mortality equally well and better than the Boey score, but none of them were optimal. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.

• #9 A practical scoring system to predict mortality in patients with perforated peptic ulcer | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0008-7

  Detection of patients with high risk for mortality after PPU surgery can allow other treatment modalities except surgery or can necessitate some extra care protocols to decrease the mortality. […] Our aim was to develop a new and easy applicable scoring system to predict mortality at PPU patients. […] Three variables were statistically significant in multivariate analysis: albumin level equal or less than 1.5 (OR=0.0445), age over 65 (OR =1.1258), and BUN level higher than 45 (OR=1.0353). […] The resulting predicting of mortality in perforated peptic ulcer (POMPP) score ranged between score 0 to 3. […] In the first group, with a score 0, there was no mortality. […] The second group included patients with POMPP score 1, who had a 7.1% risk of mortality; […] The third group, comprising approximately 4.8% of the patients, included those with a POMPP score of 2 whose risk of mortality 34.4% and last group with a POMPP score of 3 who had an 88.9% risk of mortality.

• #10 Bergen Open Research Archive: What Is the Best Predictor of Mortality in Perforated Peptic Ulcer Disease? A Population-Based, Multivariable Regression Analysis Including Three Clinical Scoring Systems

  https://bora.uib.no/bora-xmlui/handle/1956/8996

  Hypoalbuminaemia alone (37 g/l) achieved an OR of 8.7 and an AUC of 0.78. […] In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of 24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89. […] Six clinical factors predicted 30-day mortality better than available risk scores. […] Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.

• #11 Scoring system in outcome prediction of postoperative mortality and morbidity in perforated peptic ulcer

  https://www.oatext.com/scoring-system-in-outcome-prediction-of-postoperative-mortality-and-morbidity-in-perforated-peptic-ulcer.php

  Accurate and early identification of Perforated Peptic Ulcer (PPU) patients with an increased risk of adverse outcome is needed to plan and target the level of perioperative monitoring and treatment. […] The purpose of the study is to compare the accuracy of various scoring systems (Boey, PULP, ASA, MPI) in predicting morbidity and mortality in PPU. […] Early presentation, prompt diagnosis and emergent surgery are the pillars to successful management and good outcomes of PPU. The Boey and PULP score can be utilized as simple and precise predictor of postoperative mortality and morbidity in PPU patients. […] To improve the outcomes, it is important to categorize patients based on risk of developing morbidities and mortalities, so that high-risk patients can receive more appropriate treatment and better intensive care.

• #12 A practical scoring system to predict mortality in patients with perforated peptic ulcer | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0008-7

  The area under the ROC curve (AUC) was 0.931 (95% CI, 0.89-0.96). […] We described a new and easily applicable scoring system to predict the postoperative mortality rate in patients with PPU. […] POMPP is a very simple and appropriate scoring system for clinical practice that may allow surgeon to perform a rapid analysis and may help in predicting mortality rate in PPU with its construction based on objective data.

• #13 Temperature, Neutrophils and Multiple Organ Failure Score: A Simple Scoring System to Predict Mortality Following Perforated Peptic Ulcer

  https://www.sgo-iasgo.com/article/temperature,-neutrophils-and-multiple-organ-failure-score-a-simple-scoring-system-to-predict-mortality-following-perforated-peptic-ulcer

  Early detection of patients at higher risk could be useful to choose other treatment strategies except surgery to decrease the risk of mortality. […] Our results showed that TNM could help to classify patients based on their mortality risk. […] Multivariate analysis, in fact, showed that TNM stage IV and ASA score IV themselves significantly influenced the mortality. […] In our preliminary study, we want to describe our results about the use of TNM score to assess IAS after PPU.

• #14 What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24610235/

  Mortality rates in perforated peptic ulcer (PPU) have remained unchanged. The aim of this study was to compare known clinical factors and three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) in the ability to predict mortality in PPU. […] A total of 172 patients were included, of whom 28 (16 %) died within 30 days. Among the factors associated with mortality, the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had an OR of 5.0 and an AUC of 0.75. Hypoalbuminaemia alone (37 g/l) achieved an OR of 8.7 and an AUC of 0.78. In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of 24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89. […] Six clinical factors predicted 30-day mortality better than available risk scores. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.

• #15 Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-9-45

  More recently a study comparing three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) regarding the ability to predict mortality in PPU, found that the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had OR of 5.0 and AUC of 0.75. Hypoalbuminaemia alone (37 g/l) achieved OR of 8.7 and AUC of 0.78 being the strongest single predictor of mortality. A further new prognostic score has been proposed for perforated duodenal ulcers, including as predictors of poor prognosis factors such as the presence of multiple gut perforations, the size of largest perforation 0.5 cm, amount of peritoneal fluid 1000 ml, simple closure, development of complications, post-operative systemic septicaemia and winter/autumn season of presentation. The new scoring system had an overall sensitivity of 85.12% and specificity of 80.67%.

• #16 Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease – Turkish Journal of Surgery

  https://turkjsurg.com/articles/validation-of-prognostic-scoring-systems-for-predicting-30-day-mortality-in-perforated-peptic-ulcer-disease/doi/turkjsurg.4211

  The PULP score, although more complex, predicted mortality risk better than the ASA score and the Boey score. Elderly population, raised serum creatinine, time delay to surgery 24 hours, preoperative shock and pre-existing medical illness predicted poor prognosis. […] A larger study comparing more Mortality Risk Prediction Models would help to identify the risk factors in a wide variety of patients and aid in the improved risk estimation.

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