The Peptic Ulcer Perforation ( PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study.

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 Design: nationwide cohort study based on prospectively collected data. Setting: thirty-five hospitals in Denmark. Patients: a total of 2668 patients surgically treated for gastric or duodenal PPU between 1 February 2003 and 31 August 2009. Outcome measure: 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). Conclusion The PULP score accurately predicts 30-day mortality in patients operated for PPU and can assist in risk stratification and triage. [ABSTRACT FROM AUTHOR]