title: Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis.
abstract: OBJECTIVE
  By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB).
  
  
  METHODS
  We conducted systematic searches in PubMed and Embase (January 1989-January 2010). Relative risks (RRs) were pooled across selected studies and an analysis of diagnostic test accuracy was performed to validate the results further.
  
  
  RESULTS
  Of 1,572 identified studies, 16 were eligible for inclusion. Only three had a low risk of bias and the overall quality of evidence was low. The risk of death (30-day or in-hospital mortality) was significantly greater in PUB patients with comorbidity than in those without (RR: 4.44; 95% confidence interval (CI): 2.45-8.04). The pooled sensitivity for comorbidity predicting death in patients with PUB was 0.86 (95% CI: 0.66-0.95) and the pooled specificity was 0.53 (95% CI: 0.40-0.65). PUB patients with three or more comorbidities had a greater risk of dying than those with one or two (RR: 3.46; 95% CI: 1.34-8.89). All individual comorbidities that we assessed significantly increased the risk of death associated with PUB. However, RRs were higher for hepatic, renal, and malignant disease (range: 4.04-6.33; no significant heterogeneity) than for cardiovascular and respiratory disease and diabetes (2.39, 2.45, and 1.63, respectively; no significant heterogeneity).
  
  
  CONCLUSIONS
  Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.
authors: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. leontia@mcmaster.ca
authors: Grigorios I
authors: GI
authors: Leontiadis
authors: Michael
authors: M
authors: Molloy-Bland
authors: Paul
authors: P
authors: Moayyedi
authors: Colin W
authors: CW
authors: Howden
mesh_terms: D015897:Comorbidity; D017052:Hospital Mortality; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity