title: Cirrhotic patients at increased risk of peptic ulcer bleeding: a nationwide population-based cohort study.
abstract: BACKGROUND
  Few large population-based studies have compared the occurrence of peptic ulcer bleeding (PUB) in cirrhotic and noncirrhotic patients.
  
  
  OBJECTIVE
  To investigate if cirrhotic patients have higher risk of PUB than the general population and to identify possible risk factors of PUB in cirrhotic patients.
  
  
  METHODS
  Using the National Health Insurance Research Database, a nationwide population-based dataset in Taiwan and matching age, gender, comorbidities and ulcerogenic medication by propensity score, 4013 cirrhotic patients, 8013 chronic hepatitis patients and 7793 normal controls were compared. The log-rank test was used to analyse differences in accumulated PUB-free survival rates between the groups. Cox proportional hazard regressions were performed to evaluate independent risk factors for PUB in all patients and identified risk factors of PUB in cirrhotic patients.
  
  
  RESULTS
  During the 7-year follow-up, cirrhotic patients had significantly higher incidences of PUB than chronic hepatitis patients and controls, respectively (P < 0.001 by log-rank test). By Cox proportional hazard regression analysis, cirrhosis was independently associated with increased risk of PUB (hazard ratio: 4.22; 95% CI 3.37-5.29, P < 0.001) after adjusting for age, gender, economic status, underlying comorbidities and ulcerogenic medication. Age, male, diabetes, chronic renal disease, history of gastro-oesophageal variceal bleeding and use of nonsteroidal anti-inflammatory drugs were risk factors for PUB in cirrhotic patients.
  
  
  CONCLUSIONS
  Cirrhotic patients have a significantly higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like age, gender, economic status, underlying comorbidities and ulcerogenic medication.
authors: Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan. jcluo@vghtpe.gov.tw
authors: J-C
authors: JC
authors: Luo
authors: H-B
authors: HB
authors: Leu
authors: M-C
authors: MC
authors: Hou
authors: C-C
authors: CC
authors: Huang
authors: H-C
authors: HC
authors: Lin
authors: F-Y
authors: FY
authors: Lee
authors: F-Y
authors: FY
authors: Chang
authors: W-L
authors: WL
authors: Chan
authors: S-J
authors: SJ
authors: Lin
authors: J-W
authors: JW
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology