Pre-operative serum albumin and body mass index as predictors of post-operative morbidity and mortality in perforation peritonitis secondary to peptic ulcer disease

Background: Peptic ulcer disease (PUD) affects 4 million people worldwide annually. Perforated peptic ulcer is a serious complication of PUD and patients often present with acute abdomen that carries high risk for morbidity and mortality. This is worsened in patients who are malnourished. The incidence of malnutrition is around 30% in patients with gastrointestinal disease and is frequently unrecognized. Albumin or prealbumin levels may help identify these patients. Obesity is also another cause for morbidity and has deleterious effects on wound healing. Therefore this study was carried out to assess if preoperative serum albumin and body mass index can be used as predictors of morbidity and mortality in patients with perforated peptic ulcers.Methods: 70 patients with peptic perforation peritonitis presented to the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020 and were included in the study. Pre-operative Serum Albumin and BMI was noted and the patients were followed up for 30 days.Results: Mean albumin level in our study was 3.01. The patients with Serum Albumin <3.5 g/dl have more complications compared to patients with >3.5 g/dl. Morbidity and mortality increases with severity of hypoalbuminemia. This study was statistically significant with a p value <0.05. In our study, we also found that patients with abnormal BMI have more complications than patients with normal BMI but it is statistically insignificant with a p value >0.05.Conclusions: Serum albumin is a good indicator for predicting postoperative morbidity and mortality in peritonitis secondary to peptic ulcer disease.

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Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20210054 ◽

2021 ◽

Vol 8 (2) ◽

pp. 543

Author(s):

Bhanu Prakash K. R. ◽

Subhas Patil ◽

Manasa Mohan

Keyword(s):

Peptic Ulcer ◽

Morbidity And Mortality ◽

High Rate ◽

P Value ◽

Peptic Ulcer Perforation ◽

Hollow Viscus ◽

Mortality And Morbidity ◽

Ulcer Disease ◽

Ulcer Perforation ◽

Perforation Peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be <0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation >24 hours, age >65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

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Factors affecting morbidity and mortality in peptic ulcer perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20181105 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1335

Author(s):

Kadasiddeshwara G. Byakodi ◽

Harini B. S. ◽

Vasant Teggimani ◽

Narayan Kabade ◽

Abhijit Hiregoudar ◽

...

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Female Gender ◽

Morbidity And Mortality ◽

P Value ◽

High Morbidity ◽

Peptic Ulcer Perforation ◽

Female Population ◽

Ulcer Disease ◽

Ulcer Perforation

Background: Peptic ulcer disease is very common disease in developing countries and so are its complications. With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) disease has decreased dramatically, although complications of peptic ulcer disease such as perforation and bleeding have remained fairly constant.Methods: A prospective study was conducted on43 patients presenting to KIMS Hospital, Hubli with features suggestive of hollow viscus perforation and intraoperative findings suggestive of peptic ulcer perforation from January 2015 to June 2016.Results: In this study, there were 43 cases of peptic ulcer perforation. Peptic ulcer perforation was common in third decade of life(n=12) with the mean age(SD) 39.88 years. Perforation is more common in males as compared to the female population 7.6:1. Post-operative morbidity is seen in 31 (72.1%) of patients and mortality in 4 (9.3%). Smoking, Alcohol beverage consumption, regular ingestion of NSAIDs were commonly seen in patients with peptic ulcer perforation but these factors were not significant risk factors for postoperative mortality and morbidity. Age ≥60 years (p-value 0.051), Female gender (p-value 0.012), Presence of co-morbid conditions (p-value 0.055), Shock on admission (p-value 0.029, perforation-surgery interval >24 hours (p-value 0.001), preoperative higher-grade ASA, purulent intraperitoneal collection (p-value 0.002) were statistically significant predictors of mortality.Conclusions: Perforated peptic ulcer (PPU) is a life-threatening disease with historically reported high morbidity and mortality rates. Age ≥60 years, female gender, presence of co-morbidities, preoperative shock, higher ASA grade, perforation-surgery interval >24 hours, Purulent intraperitoneal collection are inter-related statistically significant predictors of mortality. Therefore, proper resuscitation from shock, improving ASA grade and decreasing delay in surgery is needed to improve overall results.

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Sarcopenia is Independently Associated with an Increased Risk of Peptic Ulcer Disease: A Nationwide Population-Based Study

Medicina ◽

10.3390/medicina56030121 ◽

2020 ◽

Vol 56 (3) ◽

pp. 121

Author(s):

Youn I Choi ◽

Jun-Won Chung ◽

Dong Kyun Park ◽

Kwang Pil Ko ◽

Kyung Oh Kim ◽

...

Keyword(s):

Body Mass Index ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Body Mass ◽

Fat Mass ◽

Activity Patterns ◽

Sarcopenic Obesity ◽

Model Assessment ◽

Ulcer Disease ◽

Increased Risk

Background and objective: Although obesity is associated with an increased risk of peptic ulcer disease (PUD), no study has evaluated the association of PUD with sarcopenia. The aim of this study was to evaluate the association of sarcopenia and obesity with PUD. Material and Methods: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV and V for 2007–2012 were used. PUD history, dietary, alcohol consumption, smoking, physical activity patterns, and other socioeconomic factors were analyzed. Sarcopenia index (appendicular skeletal muscle mass (kg) ÷ body mass index (kg/m2)) and body fat mass were determined by dual-energy X-ray absorptiometry. Univariate and multivariate analyses were performed to evaluate the association of sarcopenia with the prevalence of PUD. Results: The 7092 patients were divided into the sarcopenic obesity (SO, n = 870), sarcopenic non-obesity (n = 2676), non-sarcopenic obesity (NSO, n = 2698), and non-sarcopenic non-obesity (NSNO, n = 848) groups. The prevalence of PUD in these groups was 70 (7.9%), 170 (7.4%), 169 (6.3%), and 47 (3.8%), respectively (p < 0.001). A crude analysis revealed that the prevalence of PUD was 2.2-fold higher in the SO group than in the NSNO group (odds ratio (OR), 2.2; 95% confidence interval (CI), 1.5–3.2), the significance of which remained after adjustment for age, sex, body mass index, and HOMA-IR (homeostatic model assessment insulin resistance) score (OR, 1.9; 95% CI, 1.3–2.7). Conclusion: In conclusion, in this nationally representative cohort, the combination of muscle and fat mass, as well as obesity, was associated with an increased risk of PUD.

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The influence of the eradication ofHelicobacter pylorion gastric ghrelin, appetite, and body mass index in patients with peptic ulcer disease

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.2008.05415.x ◽

2008 ◽

Vol 23 ◽

pp. S278-S285 ◽

Cited By ~ 40

Author(s):

Eun Jeong Jang ◽

Sang Woon Park ◽

Ju Sang Park ◽

Sang Jong Park ◽

Ki-Baik Hahm ◽

...

Keyword(s):

Body Mass Index ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Body Mass ◽

Ulcer Disease

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Association of Peptic Ulcer Disease with Obesity, Serum Insulin Level and Lipid Profile

10.21203/rs.3.rs-102502/v1 ◽

2020 ◽

Author(s):

Foroogh Forghani ◽

Mahboube Mirhashemi

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Lipid Profile ◽

Gastrointestinal Disease ◽

Serum Insulin ◽

Insulin Level ◽

Contributing Factors ◽

Ulcer Disease ◽

Significant Difference

Abstract Background: PUD is a common and important type of gastrointestinal disease. Determination of contributing factors for PUD is an important issue for the development of preventive approaches. In this study, the association of Peptic Ulcer Disease with Obesity and Serum Insulin and Lipid Profile was studied.Methods: In this case-control study in Modarres Hospital in Tehran in 2019 among 170 consecutive subjects including 90 patients with PUD and 80 cases without it were enrolled and sampling tools were checklists. Serum Insulin and Lipid Profile and BMI were compared across the groupsResults: The results in this study demonstrated that Serum Insulin and Lipid Profile and BMI had no statistically significant difference between those patients with and without presence of PUD (P > 0.05).Conclusion: This study showed no statistically significant difference between those patients with and without the presence of PUD from points of Serum Insulin and Lipid Profile and BMI.

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Hospital based analytic study of peptic ulcer disease in patients with dyspeptic symptoms

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i2.2706 ◽

1970 ◽

Vol 7 (2) ◽

pp. 135-138 ◽

Cited By ~ 2

Author(s):

SK Sharma ◽

DK Maharjan ◽

PB Thapa

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Racial Difference ◽

College Teaching ◽

P Value ◽

Age Group ◽

Erosive Gastritis ◽

Ulcer Disease ◽

Peptic Disease ◽

Significant Racial Difference

Background: Peptic ulcer disease is one of the most common diseases prevalent in developing country like Nepal and with availability of endoscopy there have been increase in diagnosis and therapeutic use of endoscopy. Objective: The aim of this study is to investigate the prevalence of peptic ulcer disease in patient who came for upper gastrointestinal endoscopy in Kathmandu Medical College Teaching Hospital. Materials and methods: All patients who were referred to department of endoscopy from outpatient department (OPD) and inpatient department with symptoms like dyspepsia, upper GI bleeding were included from August 2004 to August 2008. Results: A total of 2761 patient were evaluated, with mean age group of 40.57 years (range 8- 95 years) and with sex distribution of male 1353 (49%) and female 1408 (51%) and racial difference into Aryan 2050 (74.2%) and Mongoloid 771 (25.8%). There were 983 patients (35.60%) with peptic disease which includes erosive gastritis, non erosive gastritis, duodenitis and gastroduodenitis without obvious ulcer. The prevalence of peptic disease with or without ulcer was more common in age group of 20- 49 years (n= 764, 27.67 %) with 70 patient with gastric ulcer (2.5%) and 50 patient with duodenal ulcer (1.8%). There was no significant racial difference among incidence of peptic ulcer (P value= 0.527). Conclusions: Peptic ulcer disease is a significant cause of morbidity in urban population of Nepal with more prevalent of erosive diseases in productive age group (20-49 years). However both male and female have equal incidence of peptic ulcer disease and there was no significant racial difference in its incidence. Key words: Peptic ulcer diseases; Oesophago-gastroduodenoscopy; H. pylori DOI: 10.3126/kumj.v7i2.2706 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 135-138

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Role of Vitamin D in the Management of COVID-19 Patients Regarding Morbidity and Mortality

10.53350/pjmhs211561231 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1231-1233

Author(s):

A. W. Khan ◽

H. T. Hussain ◽

Z.U. Mustafa ◽

M. A. Qamar ◽

...

Keyword(s):

Body Mass Index ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Body Mass ◽

Morbidity And Mortality ◽

P Value ◽

Mortality And Morbidity ◽

Severe Vitamin ◽

Vitamin D Levels

Aim: To determine the role of vitamin D in the management of COVID-19 patients regarding morbidity and mortality. Study Design: Prospective/Observational Place and Duration: Departments of Medicine & Pulmonology, Allama Iqbal Memorial Teaching Hospital, Sialkot and Department of Medicine, Sughra Shafi Medical Complex Narowal from 1st November 2020 to 30th April 2020. Methodology: One hundred and sixty patients of both genders diagnosed to have COVID-19, were enrolled. Patient’s ages were ranging from 17 to 70 years. The detailed demographics such as age, sex, and body mass index were recorded. 5 ml blood samples were taken from all the patients to check their vitamin D levels. Severe Vitamin D deficiency was defined as 25(OH)D <25 nmol/L (10 ng/dl). Association between mortality and morbidity was examined. Results: Ninety (56.25%) were males while 70 (43.75%) were females with mean age 40.15±17.37 years. Mean body mass index of patients was 24.16±7.26 kg/m2. Severe vitamin D deficiency was observed in 80 (50%) patients. Mortality found in 30 (18.75%) patients. Frequency of morbidity was among 66 (41.25%) patients. Patients with severe vitamin D deficiency had high rate of mortality 20 (25%) and morbidity 50 (62.5%) as compared to patients with no vitamin D deficiency had 10 (8%) mortality and 16 (20%) morbidity. A significant association was observed between severe vitamin D deficiency regarding morbidity and mortality among patients with covid-19 disease with p-value <0.05. Conclusion: The vitamin-D has strongest relationship among patients with covid-19 disease to reduce mortality and morbidity. Keywords: Morbidity, COVID-19, Vitamin D, Mortality

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Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Turkish Journal of Surgery ◽

10.5152/ucd.2014.2705 ◽

2015 ◽

Vol 31 (1) ◽

pp. 20-25 ◽

Cited By ~ 2

Author(s):

Ilhan Tas ◽

Burak Veli Ulger ◽

Akin Onder ◽

Murat Kapan ◽

Zubeyir Bozdag

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Ulcer Disease ◽

Factors Influencing

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Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.3224 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1916-1924

Author(s):

Naresh Kumar Seetlani ◽

Khalid Imran ◽

Pooja Deepak ◽

Fizza Tariq ◽

Daniyal Mirza ◽

...

Keyword(s):

Peptic Ulcer ◽

Gastrointestinal Bleeding ◽

Peptic Ulcer Disease ◽

Scoring System ◽

Upper Gastrointestinal Bleeding ◽

Morbidity And Mortality ◽

Mortality Data ◽

Ulcer Disease ◽

Variceal Bleed ◽

Upper Gastrointestinal

Objectives: Acute upper gastrointestinal bleed is one of the most common emergencies. Despite advancement in the medical field, gastrointestinal bleeding still carries significant mortality and fiscal burden on healthcare system. At present, limited data is available on the predictors of morbidity and mortality associated with acute upper gastrointestinal bleeding in our part of the country. Study Design: Descriptive analytical study. Setting: Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Material and Methods: 260 patients of 12 years and above with complaint of upper gastrointestinal bleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastro-duodenoscopy at the endoscopy suite of the hospital. Their personal data and endoscopic findings were recorded after obtaining a written consent. The patients were followed for 2 weeks to document the factors leading to their morbidity and mortality. We used Rockall scoring system to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0. Results: The survey included 260 patients having males (62·3%) more than females (37·7%) with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%) patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease being the most common etiology. The overall mortality rate of our study was 5·76%. Some factors influencing mortality of the patients were age > 60 years, comorbid, use of NSAIDS, rebleeding, deranged laboratory tests at the time of presentation- anemia (hemoglobin of < 10 g\dl), grade 3 thrombocytopenia (platelet count of < 50 cells\dl), serum creatinine > 1·5 and serum INR of > 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patient mortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding was found as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcer disease. Certain factors are found that are strongly related in deteriorating patient’s outcome. Along with it, Rockall score is also a good predictor of outcome of patients.

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Obesity and Risk of Peptic Ulcer Disease: A Large-Scale Health Check-Up Cohort Study

Nutrients ◽

10.3390/nu11061288 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1288

Author(s):

Jeung Hui Pyo ◽

Hyuk Lee ◽

Jee Eun Kim ◽

Yoon Ho Choi ◽

Tae Jun Kim ◽

...

Keyword(s):

Peptic Ulcer ◽

Cohort Study ◽

Peptic Ulcer Disease ◽

Cumulative Incidence ◽

Large Scale ◽

Obese Group ◽

P Value ◽

Ulcer Disease ◽

Obese Subjects ◽

Metabolically Healthy

The association between obesity and peptic ulcer disease (PUD) is inconclusive. To evaluate the association of obesity and metabolically healthy obesity (MHO) with PUD risk, we performed a retrospective cohort study of 32,472 subjects without PUD at baseline who underwent repeated health examinations. Participants were stratified by body mass index (BMI) and metabolically healthy state. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard modelling. During the follow-up period, 1940 PUD cases occurred. PUD, particularly gastric ulcer (GU), had significantly higher cumulative incidence in obese subjects compared to non-obese subjects (p value < 0.001). The HR for developing GU was 1.32 (95% CI, 1.16–1.49; p value <0.001); after adjusting for confounding factors (lifestyle, metabolic, and Helicobacter pylori status), the association was no more significant (p value = 0.789). For duodenal ulcer (DU), cumulative incidence between obese and non-obese groups was not significantly different (p value = 0.464). The risk of developing DU in the obese group was not significantly different from the non-obese group (HR 0.95; 95% CI, 0.83–1.09; p value = 0.469) and consistently showed no association after adjusting for metabolic parameters (p value = 0.199). Furthermore, MHO subjects had no increase in GU or DU risks. In this large cohort study, PUD risk was not associated with obesity or MHO.

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