Study On Influencing Factors For Prognosis And Predication Models Of Patients With Peptic Ulcer Perforation

Objective:To explore the influencing factors for prognosis of patients with peptic ulcer perforation after surgery,and based on this to set up a prognosis predication model for death risks specially aimed at for Chinese patients with peptic ulcer perforation.Besides,comparisons on accuracy of prognosis predication results for death risks of Chinese patients with peptic ulcer perforation of existing foreign prognosis predication models will be carried out.Method:Relevant clinical data of 136 patients with peptic ulcer perforation who were hospitalized and had received surgery in this hospital from January 2010 to August 2016 was collected,which included basic information of patients,characteristics of diseases,laboratory index,concomitant diseases,factors related to diagnosis and treatment,and incidence rate of postoperative complications(including abdominal infection,wound infection,digestive tract fistula,cardiopulmonary function abnormity,disturbance of consciousness,septicopyemia and septic shock).Classification on severity of postoperative complications has been conducted according to the grading standard of Clavien-Dindo operative complications.Besides,statistic analysis is carried out on data with Software SPSS20.0,and analysis on characteristics of clinical data is also carried out by using chi-square test of data in four-fold table or with Fisher Exact Probability,and through Wilcoxom rank-sum test and exploratory analysis on data of two independent samples.Therelationshipbetweenvariousinfluencefactorsand Clavien-Dindocomplications of level I-III and death risks(including Clavien-Dindocomplications of level IV)has been obtained.Furthermore,on the basis of the result for the prognosis of death risk in dichotomy Logistic regression analysis,prognosis predication model for death risks of Chinese PPU patients is established with weighted simulation evaluation method,and corresponding incidence rates of death risk at different scoring are obtained.Predicated prognostic ROC curve for death risk of Chinese patients of new model obtained through analysis with operating characteristic curve(ROC)of the subjects and the existing foreign prognostic predication model is acquired.Furthermore,comparisons on accuracy of the predication result have been carried out with value of area(AUC)under ROC curve for various predication models.Result:Totally 136 patients are included in this study,including 32patients with Clavien-Dindo complications of level I-III(23.5%);9 patients with Clavien-Dindo complications of level IV(6.6%);16 patients with death risk(including Clavien-Dindo complications of level IV)(11.8%),but no patients with Clavien-Dindo complications of level V(0%).High POMPP scores,severe septicopyemia,acute and chronic kidney diseases accompanied,definitive surgery and more seroperitoneum are risk factors for occurrence of Clavien-Dindo complications of level I-III(P<0.05),while advanced age,relative high value of white blood cell,severe septicopyemia and definitive surgery are risk factors for death risks(including Clavien-Dindo complications of level IV)(P<0.05).The prognostic predication model for death risk of Chinese PPU patients consists of age(1 score for age above 60,and 0 score for age no more than 60),white blood cell(1 score for concentration above10×10~9/L,and 0 score for concentration no more than 10×10~9/L),severe septicopyemia(2 scores for positive response,and 1 score for negative response)and definitive surgery(3 scores for positive response,and 1 score for negative response).The minimum score for new model is 2 scores,while the highest score is 7 scores.Besides,the incidence rate of death risk for 2,3,4 and 5 scores are respectively 0%,5.1%,16.1%and 77.8%.There is no object of study with 6 or 7 scores,and the AUC value is 0.675.The AUC value for estimation on death risk of Chinese patients with the existing foreign POMPP scoring,PULP scoring,Boey scoring and ASA scoring are respectively 0.623,0.607,0.556 and 0.552.Conclusion1.High POMPP scores,severe septicopyemia,acute and chronic renal diseases accompanied,definitive surgery and more seroperitoneum are risk factors for incidence of Clavien-Dindo complications of level I-III,while advanced age,relative high value of white blood cell,severe septicopyemia and definitive surgery are risk factors for death risk(including Clavien-Dindo complications of level IV).2.The new model can predict the prognosis of death risk,the higher the patients are scored,the larger probability for the incidence of death risk.Of all the foreign predication models,the accuracy of POMPP model on predication of the death risks of Chinese PPU patients is the highest.Meanwhile,compared with POMPP model,the accuracy of new model on predication of the death risks of Chinese PPU patients is higher.