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

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.

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

“…A Boey score of 2 or greater indicates mortality of > 30%. 47,48 A number of studies have proposed a Boey score of 3 as a contraindication to laparoscopic PPU repair; however, in our study, no significant differences in the Boey score were found between the 2 groups. 49,50 A large English population-based cohort study of Leusink and colleagues confirmed that laparoscopic repair of PPU is associated with a significant reduction in 30-day and 90-day mortality, postoperative pneumonia, and length of hospital stay.…”

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

“…The main clinical scoring systems used to predict morbidity and mortality in PPU patients are Boey score, PULP Score and Jabalpur score [ 37 , 38 ]. They are often used in conjunction with the Mannheim Peritonitis Index and ASA for improved comparison of the severity of physiologic derangement [ 38 , 40 , 41 ]. The Boey score seems to be the most disease-specific and is simple to calculate taking into consideration major medical illness, preoperative shock, and duration of perforation longer than 24 h before surgery.…”

Platelet to Lymphocyte Ratio Associated with Prolonged Hospital Length of Stay Postpeptic Ulcer Perforation Repair: An Observational Descriptive Analysis

“…Old age, late presentation, low admission blood pressure, and comorbidities are examples of these predictors. There are many scoring systems built to predict morbidity and mortality in the PPU; however, these scoring systems are complex, difficult to measure, not easy to calculate, and in real-life, usually not routinely utilized [4][5][6].…”