Impact of COPD on outcome among patients with complicated peptic ulcer.
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.
Christensen
Steffen
S
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: sc@dce.au.dk.
Thomsen
Reimar W
RW
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Tørring
Marie Louise
ML
Research Unit for General Practice, University of Aarhus, Aarhus, Denmark.
Riis
Anders
A
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Nørgaard
Mette
M
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Sørensen
Henrik T
HT
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications* / Q000453:epidemiology; D010439:Peptic Ulcer Perforation / Q000150:complications* / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000150:complications* / Q000401:mortality*; D012042:Registries; D012720:Severity of Illness Index
D005938:Glucocorticoids