Risk Factors for Acute Respiratory Distress Syndrome in Sepsis Caused by Peptic Ulcer Perforation: A Retrospective Study

Background/Objectives: Our study aimed to identify risk factors for the development of ARDS (acute respiratory distress syndrome) in patients with sepsis resulting from peptic ulcer perforation. Methods: Between January 2018 and December 2025, patients aged 18 years and older who underwent open surgery for peptic ulcer perforation and were diagnosed with sepsis due to intra-abdominal infection related to peptic ulcer perforation during postoperative follow-up or hospitalization were included in the study. Daily ARDS screening was performed within 7 days of sepsis diagnosis. Patients were divided into groups with and without ARDS. Laboratory values were recorded within the first 24 h after sepsis diagnosis, and APACHE II score, SOFA score, NEWS, and SAPS II were calculated based on these values and the patient’s clinical condition. Results: The SOFA score showed the highest discriminative ability, with an AUC of 0.710 (95% CI: 0.619–0.794) at a cutoff of 9.0, representing 54.2% sensitivity and 83.1% specificity. Albumin level showed an AUC of 0.654 (95% CI: 0.560–0.748) at a cutoff of 2.40 g/dL; its specificity was high (85.1%), but its sensitivity was relatively low (41.7%). CAR showed moderate predictive performance with an AUC of 0.627 (95% CI: 0.522–0.730) at a cutoff of 61.11, representing 60.4% sensitivity and 72.1% specificity. The combined model demonstrated the best predictive performance with an AUC of 0.727 (95% CI: 0.635–0.820), 70.8% sensitivity, and 72.7% specificity. Conclusions: SOFA score demonstrated the best overall clinical applicability for early ARDS risk stratification, while both SOFA score and APACHE II score showed independent associations with ARDS in separate multivariable models.