Preethi G K Venkatesh1, Sravanthi Parasa2, Basile Njei3, Madhusudhan R Sanaka1, Udayakumar Navaneethan1. 1. Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA. 2. Department of Medicine, Kansas University Medical Center, Kansas City, Kansas, USA. 3. Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
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.
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.
Authors: Andrew J Kruger; Khalid Mumtaz; Ahmad Anaizi; Rohan M Modi; Hisham Hussan; Cheng Zhang; Alice Hinton; Darwin L Conwell; Somashekar G Krishna; Peter P Stanich Journal: Dig Dis Sci Date: 2017-10-06 Impact factor: 3.199