Abstract：
Limited data exists on Charlson\'s weighted index of comorbidity (WIC) predictability for postoperative outcomes following perforated peptic ulcer (PPU) surgery. This study assesses the utility of WIC and other predictive scores in forecasting both postoperative mortality and morbidity in PPU.
Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver-operator characteristic (ROC) curve (AUC).
Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65 years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2 mmol/L upon presentation preoperatively. While surgery >24 h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6 h or <12 h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81-0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93-1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73-0.93; p < 0.001).
WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients\' triage for escalated care, leading to a better outcome.
Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver-operator characteristic (ROC) curve (AUC).
Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65 years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2 mmol/L upon presentation preoperatively. While surgery >24 h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6 h or <12 h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81-0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93-1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73-0.93; p < 0.001).
WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients\' triage for escalated care, leading to a better outcome.
摘要：
背景：关于Charlson的共病加权指数（WIC）对穿孔性消化性溃疡（PPU）手术后结果的可预测性的数据有限。这项研究评估了WIC和其他预测评分在预测PPU术后死亡率和发病率方面的实用性。
方法：纳入了2018年至2021年在马来西亚三级转诊中心手术的PPU患者。回顾性分析临床数据与综合并发症指数（CCI）测量的死亡率和发病率的关系。使用接受者-操作者特征（ROC）曲线（AUC）下面积检查WIC和其他预测因子的可预测性。
结果：在110名患者中，术后有18例（16.4%）死亡，36例（32.7%）死亡（高CCI，≥26.2）。死亡率和高CCI都与年龄>65岁有关。女性性别,合并症（糖尿病，高血压,和肾脏疾病)，美国麻醉医师协会评分>2。大多数死亡的病人有肾功能不全,代谢性酸中毒,术前出现乳酸>2mmol/L。虽然手术后>24小时与死亡率和高CCI相关，但未显示早期手术<6小时或<12小时的益处。WIC(AUC,0.89；95%CI，0.81-0.99）与消化性溃疡穿孔（PULP）（AUC，死亡率为0.97；95%CI，0.93-1.00）。PULP有效预测高CCI(AUC，0.83；95%CI，0.73-0.93；p<0.001)。
结论：WIC在预测死亡率方面有价值，强调合并症在风险评估中的重要性。PULP评分可有效预测死亡率和高CCI。早期识别围手术期风险高的患者将有助于患者分诊以逐步升级护理，带来更好的结果。
方法：纳入了2018年至2021年在马来西亚三级转诊中心手术的PPU患者。回顾性分析临床数据与综合并发症指数（CCI）测量的死亡率和发病率的关系。使用接受者-操作者特征（ROC）曲线（AUC）下面积检查WIC和其他预测因子的可预测性。
结果：在110名患者中，术后有18例（16.4%）死亡，36例（32.7%）死亡（高CCI，≥26.2）。死亡率和高CCI都与年龄>65岁有关。女性性别,合并症（糖尿病，高血压,和肾脏疾病)，美国麻醉医师协会评分>2。大多数死亡的病人有肾功能不全,代谢性酸中毒,术前出现乳酸>2mmol/L。虽然手术后>24小时与死亡率和高CCI相关，但未显示早期手术<6小时或<12小时的益处。WIC(AUC,0.89；95%CI，0.81-0.99）与消化性溃疡穿孔（PULP）（AUC，死亡率为0.97；95%CI，0.93-1.00）。PULP有效预测高CCI(AUC，0.83；95%CI，0.73-0.93；p<0.001)。
结论：WIC在预测死亡率方面有价值，强调合并症在风险评估中的重要性。PULP评分可有效预测死亡率和高CCI。早期识别围手术期风险高的患者将有助于患者分诊以逐步升级护理，带来更好的结果。
