Comparative performance of Boey, peptic ulcer perforation, and American Society of Anesthesiologists scores in predicting outcomes in patients with perforated peptic ulcer

Background: Perforated peptic ulcer (PPU) is a surgical emergency associated with significant morbidity and mortality. Accurate and early identification of high-risk individuals is crucial in risk stratification. The primary aim of this study is to validate three of the most commonly used scoring systems concerning PPU: Boey, peptic ulcer perforation score (PULP), Patients and Methods: This is a prospective, cohort analytic study of patients presenting to a tertiary emergency hospital requiring surgical intervention for PPU from November 2020 to April 2021. Data included patients' demography, clinical, laboratory, and intraoperative findings, postrepair 30-day morbidity and mortality. Receiver-operating characteristic (ROC) curve analysis was used to compute the area under the curve (AUC), cutoff point, sensitivity, and specificity for each of the three scores. Results: This study included 52 patients with a mean age of 45.21 and male predominance. Morbidity and mortality were 48.1% (n=25) and 17.3% (n=9), respectively. The AUC for ASA, Boey, and PULP for morbidity was 62.4, 69.8, and 69.4%, respectively. From the measured parameters, only the intraoperative perforation size was significantly associated with post-PPU 30-day morbidity. Concerning mortality, the AUC for ASA, Boey, and PULP was 84.5, 86.6, and 93.5%, respectively. Age, creatinine and lactate, time from perforation to admission/surgery, and perforation size were all significantly associated with mortality. Conclusion: PULP is the best prognostic tool for PPU patients and can be used to evaluate both morbidity and mortality.