title: How to treat esophageal perforations when determinants and predictors of mortality are considered.
abstract: BACKGROUND
  Published lethality rates of esophageal perforation (EP) vary depending on patient- and disease-related factors. This study was designed to evaluate how these factors impact death. Furthermore, we calculated the predictive accuracy of the Mortality Prediction Model (MPM II) and the Simplified Acute Physiology Score (SAPS II) for in-hospital death. Conclusions about treatment decisions were drawn based on our data and analysis of recent literature.
  
  
  METHODS
  Every patient who was treated for EP at our department from December 2001 to July 2008 is included in this study. Logistic regression analyses of various risk factors, such as etiology, time interval, size, comorbidities, localization, type of treatment, and preexisting pathologies of the esophagus on death, were performed.
  
  
  RESULTS
  Of the 41 patients diagnosed with EP, nine died (21%). The most important risk factor concerning death was cirrhosis of the liver (0 vs. 89% mortality; odds ratio, 208; P<0.001). Accuracy for lethality risk prediction was calculated with MPM II and SAPS II on admission, and afterward the characteristic increase that occurred was evaluated by using receiver operator characteristic curves. Optimal results were achieved by using a characteristic SAPS II increase (AUC 0.86; P: 0.009) after the patient was admitted to the intensive care unit.
  
  
  CONCLUSIONS
  Our study was the first to demonstrate that a rapid or continuous increase more than 40 of the daily SAPS II clearly indicates that a high risk of death is imminent. This should be used as a reevaluation factor when choosing a treatment strategy.
authors.affiliation: Department of Surgery, St. Franziskus Hospital Flensburg, Waldstr. 17, 24939, Flensburg, Germany. andrej.udelnow@malteser.de
authors.forename: Andrej
authors.initials: A
authors.lastname: Udelnow
authors.forename: Markus
authors.initials: M
authors.lastname: Huber-Lang
authors.forename: Markus
authors.initials: M
authors.lastname: Juchems
authors.forename: Karl
authors.initials: K
authors.lastname: Träger
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: Peter
authors.initials: P
authors.lastname: Würl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D015897:Comorbidity; D003663:Decision Trees; D004939:Esophageal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006305:Health Status Indicators; D017052:Hospital Mortality; D008103:Liver Cirrhosis / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies