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

## TL;DR

This study created a scoring system to predict if non-surgery treatment will succeed for patients with peptic ulcer perforation.

## Contribution

The novel contribution is a new predictive scoring system (PPAP score) for nonoperative treatment success in peptic ulcer perforation.

## Key findings

- The PPAP score achieved an area under the ROC curve of 0.799, indicating good predictive performance.
- The model includes factors like age, heart rate, and peritoneal irritation signs to predict treatment success.

## Abstract

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.

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.

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.

A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability.

This multicenter retrospective study developed a scoring system (PPAP score) to predict the success of nonoperative management (NOM) in patients with perforated peptic ulcer. The model, based on clinical data at diagnosis, showed good predictive performance with an AUROC of 0.799.