Koranne Aboli, Byakodi K G, Teggimani Vasant, Kamat Vijay V, Hiregoudar Abhijith
Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
Surg J (N Y). 2022 Aug 2;8(3):e162-e168. doi: 10.1055/s-0042-1743526. eCollection 2022 Jul.
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. 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. 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 -value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had -value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a -value of 0.047. 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.
尽管在药物治疗方面取得了进展，但消化性溃疡疾病在大多数发展中国家仍然是一个主要的公共卫生问题。穿孔的发生率仍然很高，并且是溃疡疾病所有并发症中死亡率最高的。对病例进行风险分层将有助于更好的术前管理和重症监护病房资源的有效利用。本研究的目的是比较现有的不同评分系统，并确定消化性溃疡穿孔（PPU）病例中最准确的死亡率预测指标。
这是一项在印度胡布利卡纳塔克医学科学研究所进行的观察性研究。纳入了2017年12月至2019年8月期间接受手术治疗的所有PPU疾病病例。收集了人口统计学数据，并计算了每个患者的消化性溃疡穿孔（PULP）评分、曼海姆腹膜炎指数（MPI）、美国麻醉医师协会（ASA）评分和贾巴尔普尔评分（JS）并进行比较。在术后对患者进行随访。
共有45例患者纳入研究，平均年龄为42.5岁。大多数患者在症状出现24小时内就诊。8.9%的患者使用过非甾体抗炎药，2.2%的患者使用过类固醇。45例患者中有7例死亡报告。在各种评分系统中，MPI和JS是更好的死亡率预测指标，P值分别<0.001和0.007。相比之下，PULP和ASA评分的P值无统计学意义。然而，PULP评分是术后并发症的更好预测指标，P值为0.047。
在验证的四个评分系统中，MPI和JS是给定人群中死亡率的更好预测指标。在本研究中，PULP评分是术后并发症的更好预测指标。
