title: What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems.
abstract: BACKGROUND
  Mortality rates in perforated peptic ulcer (PPU) have remained unchanged. The aim of this study was to compare known clinical factors and three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) in the ability to predict mortality in PPU.
  
  
  METHODS
  This is a consecutive, observational cohort study of patients surgically treated for perforated peptic ulcer over a decade (January 2001 through December 2010). Primary outcome was 30-day mortality.
  
  
  RESULTS
  A total of 172 patients were included, of whom 28 (16 %) died within 30 days. Among the factors associated with mortality, the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had an OR of 5.0 and an AUC of 0.75. Hypoalbuminaemia alone (≤37 g/l) achieved an OR of 8.7 and an AUC of 0.78. In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of >24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89.
  
  
  CONCLUSIONS
  Six clinical factors predicted 30-day mortality better than available risk scores. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway, kenneththors@gmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Thorsen
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Søreide
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D004381:Duodenal Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University; D006801:Humans; D034141:Hypoalbuminemia / Q000175:diagnosis* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D010439:Peptic Ulcer Perforation / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult