Development of a Scoring System to Predict the Treatment Success for Nonoperative Management of Peptic Ulcer Perforation - A Secondary Data Analysis of PPAP Study

Sep 28, 2026

Uploaded by dawugda

Although surgical treatment is the primary measure for patients with perforated peptic ulcer, nonoperative management is widely used as an alternative. A clinically applicable scoring system was developed to predict NOM success using retrospective data from the Perforated Peptic ulcer Analyzing Project cohort (adult PPU cases, 2011–2022). Success was defined as survival to discharge without surgery. Multivariable logistic regression identified predictors and a weighted PPAP score; it showed AUROC 0.799 with a cut-off of 56, requiring external validation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Purpose of the study

Methods

Study design and setting

Data analysis and scoring model

Results

Patient cohort and NOM outcomes

Scoring system performance

Conclusion

Annals of Gastroenterological Surgery ORIGINAL ARTICLE OPEN ACCESS Development of a Scoring System to Predict the Treatment Success for Nonoperative Management of Peptic Ulcer Perforation: A Secondary Data Analysis of PPAP Study Kei Ito1 | Akira Endo2 | Hiromasa Hoshi2 | Koji Ito3 | Tomohiro Akutsu2 | Hikaru Odera4 | Hideto Shiraki5 | Takeshi Yokoyama6 | Yasukazu Narita7 | Taro Masuda8 | Akira Suekane4 | Shigeru Yamagishi9 | Koji Morishita4 1Department of Acute Care Surgery, Fujisawa City Hospital, Fujisawa, Japan | 2Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan | 3Department of Gastroenterological Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan | 4Department of Acute Critical Care and Disaster Medicine, Institute of Science Tokyo, Meguro, Japan | 5Department of Surgery, Chiba Rosai Hospital, Chiba, Japan | 6Department of Surgery, Ohtanishinouchi General Hospital, Koriyama, Japan | 7Department of Surgery, Mito Medical Center, Higashiibaraki, Japan | 8Department of Emergency and Critical Care Center, Matsudo City General Hospital, Matsudo, Japan | 9Department of Surgery, Fujisawa City Hospital, Fujisawa, Japan Correspondence: Kei Ito ([keiito1214@gmail.com](keiito1214@gmail.com)) Received: 26 April 2025 | Revised: 24 July 2025 | Accepted: 30 July 2025 Funding: The authors received no specific funding for this work. Keywords: general surgery | nonoperative management | peptic ulcer perforation ABSTRACT Background: Although surgical treatment is the primary measure for patients with perforated peptic ulcer (PPU), nonoperative management (NOM) has become a common alternative. However, risk score models predicting the success of NOM based on the analysis of a large number of patients remain scarce. We developed a clinically applicable scoring system to predict the success of NOM in patients with PPU using data from a large cohort. Method: We analyzed data of the Perforated Peptic ulcer Analyzing Project (PPAP), which was a retrospective survey of adult patients with PPU between January 2011 to December 2022. The successful NOM case was defined as patients who survived until hospital discharge without requiring surgery. Factors associated with NOM were identified using a multivariable logistic regression analysis, and a scoring system to predict NOM was developed by weighting these factors based on the regression coefficients. Result: Of 702 potentially eligible patients, 584 were treated with NOM, of which 130 patients (22.2%) were treated successfully. Age, sex, body temperature, heart rate, the extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis were included in the final model. Using these variables, we developed the scoring system named PPAP score, which had favorable discriminating ability with the area under receiving operating characteristic curve of 0.799. When the cut-off was set to 56, the sensitivity and the specificity were 0.738 and 0.722, respectively. Conclusion: A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability. | List of Abbreviations: Alb, albumin; AUROC, area under the receiver operating characteristic curve; BT, body temperature; CCI, Charlson Comorbidity index; Cre, creatinine; CRP, C reactive protein; CT, computed tomography; Hb, hemoglobin; HR, heart rate; NOM, nonoperative management; PPU, perforated peptic ulcer; RCT, randomized controlled trial; sBP, systolic blood pressure; WBC, white blood cell counts. | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2025 The Author(s). Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery. | Anna

FAQs

How is successful nonoperative management defined in this study?

Successful NOM is defined as patients surviving until hospital discharge without requiring surgery.

Which variables were included in the final PPAP scoring model?

The final model includes age, sex, body temperature, heart rate, extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis.

What performance did the PPAP score achieve for predicting NOM success?

The PPAP score showed an AUROC of 0.799; at a cut-off of 56, sensitivity was 0.738 and specificity was 0.722.

Sep 28, 2026

Uploaded by dawugda