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Increased mortality with peptic ulcer bleeding in patients with both compensated and decompensated cirrhosis.
Gastrointest Endosc. 2013 Oct 8;
Authors: Venkatesh PG, Parasa S, Njei B, Sanaka MR, Navaneethan U
Abstract
BACKGROUND: Cirrhosis is associated with worse outcomes in peptic ulcer bleeding (PUB). There are no population-based studies from the United States on the impact of cirrhosis on PUB outcomes.
OBJECTIVE: To investigate the impact of cirrhosis on outcomes of patients with PUB.
DESIGN: Cross-sectional study.
SETTING: Nationwide Inpatient Sample 2009.
PATIENTS: International Classification of Diseases, the 9th revision, codes were used to identify patients with PUB and cirrhosis. The control group was patients with PUB without cirrhosis.
MAIN OUTCOME MEASUREMENTS: In-hospital mortality, length of stay, and hospitalization costs.
RESULTS: A total of 96,887 discharges with PUB as a diagnosis were identified-3574 with PUB and cirrhosis and 93,313 with PUB alone without cirrhosis. Mortality of PUB with concomitant cirrhosis was higher than in the control group without cirrhosis (5.5% vs 2%; P = .01); decompensated cirrhosis had higher mortality than did compensated cirrhosis (6.6% vs 3.9%; P = .01). In multivariate analysis, the presence of cirrhosis independently increased mortality (adjusted odds ratio (aOR) 3.3; 95% confidence interval [CI], 2.2-4.9). Stratified analysis showed that decompensated cirrhosis (aOR 4.4; 95% CI, 2.6-7.3) had higher mortality than compensated cirrhosis (aOR 1.9; 95% CI, 1.04-3.6). There was no difference in the proportion of patients who underwent endoscopy within 24 hours (51.9% vs 51.1%; P = .68) between those with cirrhosis and controls. Patients with cirrhosis received less surgical intervention (aOR 0.8; 95% CI, 0.6-0.9) compared with controls. Hospitalization costs also were increased in patients with decompensated cirrhosis.
LIMITATIONS: Administrative data set.
CONCLUSION: Both decompensated and compensated cirrhosis are associated with increased mortality in patients with PUB.
PMID: 24119507 [PubMed - as supplied by publisher]