Prognostic Scoring and Risk Factor Analysis in Perforated Peptic Ulcer Disease: A Tertiary Centre Study

Article Sidebar

Abstract View PDF Download PDF
Published: Aug 4, 2026
DOI: https://doi.org/10.21590/jsa.04.01.02
Keywords:
Perforated Peptic Ulcer, PULP score, ASA Score, Risk Factors, Mortality

Main Article Content

Harshit Sharma
Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
Dinesh Kumar
Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
Ravi Raj Patil
Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Abstract

Background: Perforated peptic ulcer disease (PPUD) is a global health issue with significant morbidity and mortality. This study aims to investigate predisposing factors for PPUD and evaluate the efficacy of the Peptic Ulcer Perforation (PULP) score in predicting patient outcomes at a tertiary care center in Uttar Pradesh.
Methods: This prospective cross-sectional study was conducted over one year and included 53 patients diagnosed with a perforated peptic ulcer. Data on demographics, clinical presentation, comorbidities, laboratory results, and intraoperative findings were collected. The PULP and American Society of Anesthesiologists (ASA) scores were calculated for each patient. Outcomes, including postoperative complications and mortality, were analyzed. Statistical analysis was performed using chi-square and independent t-tests, with a p-value of <0.05 considered significant.
Results: The study population was predominantly male. Mortality was significantly associated with advanced age (p = 0.027), with 57.14% of non-survivors being over 60 years old. Comorbidities such as diabetes mellitus and hypertension were significantly more common in non-survivors (p = 0.029). Non-survivors had significantly higher heart and respiratory rates and lower systolic blood pressure. Laboratory findings revealed that non-survivors had significantly higher total leukocyte counts, urea, creatinine, and INR levels (p <0.05). Postoperative complications like ARDS, leak, and sepsis were significantly more frequent in the non-survivor group (p <0.001). Higher PULP and ASA scores were strongly correlated with increased mortality (p <0.001).
Conclusion: Advanced age, comorbidities, physiological instability, renal dysfunction, and coagulopathy are key predictors of mortality in PPUD. The PULP score is a reliable and effective prognostic tool for risk stratification. Early identification of these risk factors and prompt intervention are crucial for improving clinical outcomes.

Article Details

How to Cite
Sharma, H., Kumar, D., & Patil, R. R. (2026). Prognostic Scoring and Risk Factor Analysis in Perforated Peptic Ulcer Disease: A Tertiary Centre Study. Journal of Surgery Archives, 4(01), 5–8. https://doi.org/10.21590/jsa.04.01.02
Issue
Vol. 4 No. 01 (2026): JOURNAL OF SURGERY ARCHIVES
Section
ORIGINAL ARTICLE
Author Biographies

Dinesh Kumar, Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Prof. (Dr.) Dinesh Kumar

MBBS, M.S., M.Ch. (Pediatric Surgery), PDF (Pediatric Urology)

Professor,

Department of Surgery,

Moti Lal Nehru Medical College,

Prayagraj

Ravi Raj Patil, Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India

Dr. Ravi Raj Patil

MBBS, MS

Assistant Professor

Department of Surgery,

Moti Lal Nehru Medical College, Prayagraj

References

Milosavljevic T, Kostić-Milosavljević M, Jovanović I, Krstić M. Complications of peptic ulcer disease. Dig Dis. 2011;29(5):491-493. doi:10.1159/000331517

Christensen S, Riis A, Nørgaard M, Sørensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr. 2007 Apr 17;7:8. doi: 10.1186/1471-2318-7-8. PMID: 17439661; PMCID: PMC3225863.

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-113. doi:10.1159/000323958

Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017 Jan 27;9(1):1-12. doi: 10.4240/wjgs.v9.i1.1. PMID: 28138363; PMCID: PMC5237817.

Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613-624. doi:10.1016/S0140-6736(16)32404-7

Møller MH, Shah K, Bendix J, et al. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol. 2009;44(2):145-152. doi:10.1080/00365520802401261

Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205(1):22-26. doi:10.1097/00000658-198701000-00005

Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33(1):80-85. doi:10.1007/s00268-008-9796-1

Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56(5):655-662. doi:10.1111/j.1399-6576.2011.02609.x

Sengupta, S., Ramesh, K. H., Malik, S., Bisen, R., & Akther, M. J. (2023). Perforated peptic ulcer: a clinical study at Shri. Shankaracharya institute of medical sciences Bhilai, Chhattisgarh. International Surgery Journal, 10(11), 1771–1776. https://doi.org/10.18203/2349-2902.isj20233335

Menekse, E., Kocer, B., Topcu, R. et al. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg 10, 7 (2015). https://doi.org/10.1186/s13017-015-0008-7

Patel S, Kalra D, Kacheriwala S, Shah M, Duttaroy D. Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease. Turk J Surg. 2019;35(4):252-258. Published 2019 Dec 16. doi:10.5578/turkjsurg.4211

Rivai MI, Suchitra A, Janer A. Evaluation of clinical factors and three scoring systems for predicting mortality in perforated peptic ulcer patients, a retrospective study. Ann Med Surg (Lond). 2021;69:102735. Published 2021 Aug 21. doi:10.1016/j.amsu.2021.102735

Saafan T, El Ansari W, Al-Yahri O, et al. Assessment of PULP score in predicting 30-day perforated duodenal ulcer morbidity, and comparison of its performance with Boey and ASA, a retrospective study. Ann Med Surg (Lond). 2019;42:23-28. Published 2019 May 10. doi:10.1016/j.amsu.2019.05.001