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The P eptic U lcer P erforation ( PULP ) score: a predictor of mortality following peptic ulcer perforation. A cohort study
Author(s) -
MØLLER M. H.,
ENGEBJERG M. C.,
ADAMSEN S.,
BENDIX J.,
THOMSEN R. W.
Publication year - 2012
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02609.x
Subject(s) - medicine , receiver operating characteristic , cohort , triage , perforation , area under the curve , cirrhosis , surgery , gastroenterology , emergency medicine , materials science , punching , metallurgy
Background Accurate and early identification of high‐risk surgical patients with perforated peptic ulcer ( PPU ) is important for triage and risk stratification. The objective of the present study was to develop a new and improved clinical rule to predict mortality in patients following surgical treatment for PPU . Methods Design: nationwide cohort study based on prospectively collected data. Setting: thirty‐five hospitals in D enmark. Patients: a total of 2668 patients surgically treated for gastric or duodenal PPU between 1 F ebruary 2003 and 31 A ugust 2009. Outcome measure: 30‐day mortality. Results We derived a new clinical prediction rule for 30‐day mortality and evaluated and compared its prognostic performance with the A merican S ociety of A naesthesiologists ( ASA ) and Boey scores. A total of 708 patients (27%) died within 30 days of surgery. The P eptic U lcer P erforation ( PULP ) score – comprised eight variables with an adjusted odds ratio of more than 1.28: 1) age > 65 years, 2) active malignant disease or AIDS , 3) liver cirrhosis, 4) steroid use, 5) time from perforation to admission > 24 h, 6) pre‐operative shock, 7) serum creatinine > 130 μM , and 8) the four levels of the ASA score (from 2 to 5). The score predicted mortality well (area under receiver operating characteristics curve ( AUC ) 0.83). It performed considerably better than the B oey score ( AUC 0.70) and better than the ASA score alone ( AUC 0.78). Conclusion The PULP score accurately predicts 30‐day mortality in patients operated for PPU and can assist in risk stratification and triage.