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Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a
G L Nielsen1, H T Sørensen, L Mellemkjoer
1Department of Clinical Epidemiology at Aarhus University Hospitals, Aarhus, Denmark.
Insights
Systemic corticosteroid use significantly increases upper gastrointestinal bleeding hospitalization risk. This risk is higher when combined with other medications, highlighting the need for careful patient monitoring.
Area of Science:
- Gastroenterology
- Pharmacology
- Epidemiology
Background:
- Systemic corticosteroids are widely prescribed for various inflammatory and autoimmune conditions.
- Concurrent use of other medications can potentially modify the gastrointestinal safety profile of corticosteroids.
Purpose of the Study:
- To evaluate the association between systemic corticosteroid use and the risk of hospitalization for upper gastrointestinal bleeding.
- To assess the impact of concomitant medications on this risk.
Main Methods:
- Population-based cohort study utilizing prescription and hospital discharge data from North Jutland County, Denmark (1991-1995).
- Comparison of observed upper gastrointestinal bleeding hospitalizations among corticosteroid users against expected rates in the general population.
Main Results:
- A total of 45,980 patients were included, with 18,379 person-years of corticosteroid exposure.
- Corticosteroid users had a 4.2-fold increased risk of upper gastrointestinal bleeding hospitalization (95% CI: 3.4-5.0).
- The risk was elevated (2.9-fold) even without other associated drugs and reduced with former versus current use (1.9-fold).
Conclusions:
- Systemic corticosteroid therapy is associated with a significantly increased risk of upper gastrointestinal bleeding hospitalization.
- Concomitant medication use amplifies this risk, underscoring the importance of medication review.
- Potential confounding by the underlying disease necessitating corticosteroid treatment may also contribute to the observed association.
Purpose:
We assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding.
Subjects And Methods:
We conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal anti-inflammatory drugs, aspirin, and anticoagulants during 1991 to 1995 were obtained from a countywide prescription database. All hospitalizations because of upper gastrointestinal bleeding were identified through the Hospital Discharge Registry. The observed numbers of patients with gastrointestinal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population who did not receive prescriptions for any of the drugs under study.
Results:
A total of 45,980 patients accrued 18,379 person-years of corticosteroid use. There were 109 hospital admissions for gastrointestinal bleeding among corticosteroid users, compared with 26 expected, yielding a relative risk of 4.2 [95% confidence interval (CI): 3.4 to 5.0]. Among corticosteroid users who did not use other drugs associated with gastrointestinal bleeding, the relative risk was 2.9 (95% CI: 2.2 to 3.7). The relative risk decreased further to 1.9 (95% CI: 1.4 to 2.5) when current corticosteroid usage was compared with former usage.
Conclusion:
We observed an increased risk of hospitalization because of upper gastrointestinal bleeding among patients prescribed corticosteroids, especially among those who use other medications. Confounding from the underlying disease may also have contributed to the observed increase in risk.