Prognostic Factors and Biomarker Performance in Predicting Mortality and Complications After Surgical Repair of Perforated Peptic Ulcer: A Retrospective Cohort Study

INTRODUCTION: Perforated peptic ulcer (PPU) remains a life-threatening surgical emergency with substantial morbidity and mortality. Early identification of high-risk patients is essential for guiding operative strategy and optimizing perioperative care. This study evaluated clinical, biochemical, and operative predictors of post-operative complications and 30-day mortality and assessed the prognostic performance of routine biomarkers.
METHODS: A retrospective cohort study was conducted including 114 adults who underwent surgical repair for intraoperatively confirmed PPU between May 2022 and September 2025 at a tertiary center in Istanbul, Türkiye. Demographics, American Society of Anesthesiologists (ASA) class, symptom-to-surgery interval, operative details, and baseline laboratory values (lactate, C-reactive protein [CRP], albumin, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio) were analyzed. Primary outcomes were 30-day post-operative complications and all-cause 30-day mortality. Multivariable logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis evaluated biomarker performance.
RESULTS: Post-operative complications occurred in 28.1% of patients, with a 30-day mortality of 7.9%. Complications were significantly lower after laparoscopic repair (10.7%) than open repair (32.9%), with the open group showing more adverse baseline biomarker profiles. On multivariable analysis, elevated lactate (≥2.5 mmol/L; odds ratio [OR] 8.33) and higher ASA class (II–IV; OR 2.51) independently predicted complications, while advanced age (≥53 years; OR 1.085/year) and hypoalbuminemia (<31 g/L; OR 0.805) predicted 30-day mortality. ROC analysis showed excellent discrimination for age (area under the curve [AUC] 0.883) and albumin (AUC 0.895) in predicting mortality, and both lactate and CRP strongly predicted selection of an open surgical approach.
DISCUSSION AND CONCLUSION: Advanced age, elevated ASA class, and biochemical abnormalities – particularly elevated lactate and low serum albumin – are independent predictors of post-operative complications and mortality following PPU repair. Incorporation of these readily available markers into pre-operative assessment may improve risk stratification, guide operative approach selection, and optimize perioperative management. Prospective studies are warranted to validate thresholds and develop standardized protocols.

Keywords: Albumin, biomarkers, complications, lactate, laparoscopic repair, mortality, perforated peptic ulcer, surgical outcomes