The modified Boey score (mBoey) for outcome prediction in patients with perforated peptic ulcer complicated by diffuse peritonitis: a retrospective study

Abstract

Background several scoring systems are developed to stratify the patients with perforated peptic ulcer (PPU), complicated by peritonitis. The aim of this study was to evaluate the accuracy of different scoring systems in outcome prediction in patients following surgical treatment for PPU complicated by diffuse peritonitis and to determine the possibility of enhancing the Boey score prognostic performance based on the addition of an age factor. Methods this is a retrospective multicenter study of 153 patients surgically treated for PPU with diffuse peritonitis in Pirogov Russian National Research Medical University's surgical clinics during 2014–2016 years. The outcome prediction accuracy of the modified Boey score (mBoey), Boey score, peptic ulcer perforation (PULP) score, the American Society of Anaesthesiologists (ASA) score, Mannheim peritonitis index (MPI) and WSES sepsis severity score (WSES SSS) was evaluated by receiver operating characteristics curve (ROC) analysis, and the corresponding areas under the curve (AUC) were compared. Results all scores demonstrated the high quality of the model according to the AUC values, both in relation to mortality and postoperative complications - from good (WSES SSS) to perfect (mBoey, Boey, PULP, ASA).The modified mBoey predicted morbidity (AUC – 0.932) and mortality (AUC – 0.943) better than other prognostic scoring systems. Conclusions the use of prognostic scores allows identifying the high-risk patients with perforated peptic ulcers complicated by diffuse peritonitis. The modified prognostic score developed by adding an age factor to Boey score was found to be superior in prediction of morbidity and mortality after repair of PPU.