title: The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study.
abstract: 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
  
  
  
  METHODS
  nationwide cohort study based on prospectively collected data.
  
  
  METHODS
  thirty-five hospitals in Denmark.
  
  
  METHODS
  a total of 2668 patients surgically treated for gastric or duodenal PPU between 1 February 2003 and 31 August 2009.
  
  
  METHODS
  30-day mortality.
  
  
  RESULTS
  We derived a new clinical prediction rule for 30-day mortality and evaluated and compared its prognostic performance with the American Society of Anaesthesiologists (ASA) and Boey scores. A total of 708 patients (27%) died within 30 days of surgery. The Peptic Ulcer Perforation (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 Boey score (AUC 0.70) and better than the ASA score alone (AUC 0.78).
  
  
  CONCLUSIONS
  The PULP score accurately predicts 30-day mortality in patients operated for PPU and can assist in risk stratification and triage.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Bispebjerg, Denmark. mortenhylander@gmail.com
authors.forename: M H
authors.initials: MH
authors.lastname: Møller
authors.forename: M C
authors.initials: MC
authors.lastname: Engebjerg
authors.forename: S
authors.initials: S
authors.lastname: Adamsen
authors.forename: J
authors.initials: J
authors.lastname: Bendix
authors.forename: R W
authors.initials: RW
authors.lastname: Thomsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology; D019540:Area Under Curve; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis* / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult