Evaluation of predictive factors for morbidity and mortality in patients undergoing surgery for peptic ulcer perforation.

BACKGROUND: Peptic ulcer perforation (PUP) is a life-threatening complication with high mortality caused by the leakage of gastric contents into the peritoneal cavity, leading to peritonitis. Systemic inflammatory indices, such as the C-reactive protein (CRP)/lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and multi-inflammatory indices (MII), reflect inflammation severity. This study aimed to investigate the predictive value of the CRP/Lymphocyte ratio, NLR, platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and MII indices for estimating morbidity and mortality in patients undergoing surgery for PUP. METHODS: This retrospective analysis included 319 patients who underwent surgery for PUP between October 2012 and January 2025. Pre-operative inflammatory indices were calculated from laboratory data and correlated with post-operative complications, length of hospital stay, and mortality. RESULTS: Higher CRP/Lymphocyte ratio, PLR, MII-1, MII-2, and MII-3 values were associated with fatal outcomes (p<0.05). The MII-2 and MII-3 indices best predicted post-operative complications with superior area under the curve (AUC) values (AUC: 0.655, 0.661, respectively) (p<0.001). All analyzed markers were significantly elevated in patients with prolonged hospitalization. Notably, the MII-2 index and CRP/lymphocyte ratio showed balanced sensitivity and high specificity for predicting mortality (AUC: 0.780, 0.787, respectively) (p<0.001). CONCLUSION: The MII-2 index and CRP-to-lymphocyte ratio are strong predictors of mortality in PUP patients, whereas the MII-2 and MII-3 indices are most effective for predicting complications. Incorporating these easily calculated indices into clinical practice can enhance risk stratification and decision-making.