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Impact of COPD on outcome among patients with complicated peptic ulcer
Steffen Christensen1, Reimar W Thomsen1, Marie Louise Tørring2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face higher short-term mortality after peptic ulcer bleeding or perforation. This study highlights COPD as a significant risk factor for mortality in these patients.
Area of Science:
- Pulmonary Medicine
- Gastroenterology
- Critical Care
Background:
- Chronic obstructive pulmonary disease (COPD) is linked to increased peptic ulcer disease risk.
- Limited data exist on COPD's impact on short-term mortality in patients with bleeding and perforated peptic ulcers.
Purpose of the Study:
- To examine the association between COPD and 30-day mortality in patients experiencing peptic ulcer bleeding or perforation.
Main Methods:
- Retrospective cohort study of patients hospitalized with peptic ulcer perforation or bleeding in northern Denmark (1991-2004).
- Data on COPD, comorbidities, and prescriptions obtained from medical databases.
- Mortality ascertained via the Danish Civil Registration System; 30-day mortality rates and rate ratios computed using regression analysis.
Main Results:
- COPD patients with perforated peptic ulcers had a 30-day mortality rate of 44.0% vs. 25.5% for non-COPD patients (adjusted MRR, 1.48).
- COPD patients with bleeding peptic ulcers had a 30-day mortality rate of 16.5% vs. 10.8% for non-COPD patients (adjusted MRR, 1.38).
- Oral glucocorticoid use in COPD patients correlated with higher mortality for both ulcer types.
Conclusions:
- COPD significantly increases 30-day mortality risk for patients with bleeding and perforated peptic ulcers.
- COPD is an independent risk factor for adverse outcomes in peptic ulcer disease.
Background:
COPD is associated with an increased risk of peptic ulcer disease, but limited data exist on whether COPD influences short-term mortality among patients with bleeding and a perforated peptic ulcer. We examined the association between COPD and 30-day mortality following bleeding and perforation of a peptic ulcer.
Methods:
We identified all patients who had been hospitalized with a first-time diagnosis of peptic ulcer perforation (n = 2,033) or bleeding (n = 7,486) in northern Denmark between 1991 and 2004. Information on COPD, comorbidities, and filled prescriptions was obtained from medical databases. Mortality was ascertained using the Danish Civil Registration System. We computed the cumulative 30-day mortality rates for ulcer patients with COPD and for other ulcer patients, and used regression analysis to obtain the 30-day mortality rate ratios (MRRs), controlling for potential confounding factors.
Results:
Among patients who were hospitalized with perforated peptic ulcers, 218 (10.7%) had previously been hospitalized with COPD. The 30-day mortality rate was 44.0% among perforated ulcer patients with COPD vs 25.5% among other ulcer patients (adjusted MRR, 1.48; 95% confidence interval [CI], 1.18 to 1.85). Among patients hospitalized with a bleeding peptic ulcer, 759 (10.1%) had previously been hospitalized with COPD. The 30-day mortality rate was 16.5% among bleeding peptic ulcer patients with COPD vs 10.8% among other ulcer patients (adjusted MRR, 1.38; 95% CI, 1.14 to 1.68). The use of oral glucocorticoids among COPD patients was associated with higher MRRs for both perforated and bleeding peptic ulcers.
Conclusions:
COPD substantially increased 30-day mortality among patients with bleeding and perforated peptic ulcers.
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