Subscribe to RSS
A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers
Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases.
Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period.
Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p-value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p-value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p-value of 0.047.
Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.
Keywordsperforated peptic ulcer - mortality - peptic ulcer perforation score - Mannheim peritonitis index - Jabalpur score - American Society of Anesthesiologists score
Received: 30 March 2021
Accepted: 24 January 2022
Article published online:
02 August 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Teitelbaum EN, Hingness ES, Mahvi DM. Stomach. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Vol. 2. First South Asia Edition. Elsevier; 1188-1236
- 2 Ghosh BC, Gangopadhyay A, Ghosh G. Assessment of recent epidemiological trends in peptic ulcer perforation patients in an eastern Indian tertiary hospital. Asian J Med Sci 2018; 9 (06) 68-75
- 3 Jain NK, Jain MG, Maini S, Khobragade V. A study of clinical profile and management of perforation peritonitis in a tertiary health centre located in Central India. Int Surg J. 2017; 4 (03) 981
- 4 Patel S, Kalra D, Kacheriwala S, Shah M, Duttaroy D. Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease. Turk J Surg 2019; 35 (04) 252-258
- 5 Sivaram P, Sreekumar A. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg 2018; 44 (02) 251-257
- 6 Buck DL, Vester-Andersen M, Møller MH. Danish Clinical Register of Emergency Surgery. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br J Surg 2013; 100 (08) 1045-1049
- 7 Tarasconi A, Coccolini F, Biffl WL. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 2020; 15: 3
- 8 Møller MH, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation A cohort study: The Peptic Ulcer Perforation (PULP) score. Acta Anaesthesiol Scand. 2012; 56 (05) 655-662 DOI: 10.1111/j.1399-6576.2011.026 09.x.
- 9 Kumar R, Gupta R, Sharma A, Chaudhary R. Descriptive study regarding the etiological factors responsible for secondary bacterial peritonitis in patients admitted in a tertiary care hospital in Trans Himalayan region. Int J Health Sci Res 2020; (07) 4
- 10 Bali RS, Sharma AK, Soni RK. Etiology and management of perforation peritonitis: perspective from developing world. Int Surg J 2017; 4 (09) 3097-3100
- 11 Burdick H, Pino E, Gabel-Comeau D. et al. Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Health Care Inform. 2020; 27 (01) e100109 DOI: 10.1136/b mjhci-2019-10 0109.
- 12 Thorsen K, Søreide JA, 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 (07) 1261-1268
- 13 Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models - are existing models sufficient? A retrospective cohort study. Int J Surg 2015; 14: 38-44
- 14 Prakash GV, Reddy VK, Rao BS. et al. Comparison of the efficacy of Jabalpur prognostic scoring system with Mannheims peritonitis index in evaluation of prognosis in patients with perforation peritonitis. Int Surg J 2019; 6 (07) 2390
- 15 Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg 2015; 10: 7
- 16 Sundararajan A. A comparative study of PULP score versus Jabalpur score in predicting outcome in patients with peptic ulcer perforations. IOSR J Dent Med Sci 2017; 16 (08) 35-36
- 17 Cirocchi R, Soreide K, Di Saverio S. et al. Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduodenal ulcers. J Trauma Acute Care Surg 2018; 85 (02) 417-425
- 18 Chan KS, Wang YL, Chan XW, Shelat VG. Outcomes of omental patch repair in large or giant perforated peptic ulcer are comparable to gastrectomy. Eur J Trauma Emerg Surg 2021; 47 (06) 1745-1752