Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis: A nationwide cohort study.
Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45-0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.
Division of Hepatogastroenterology, Department of Internal Medicine Department of Pharmacy, Kaohsiung Gang Gung Memorial Hospital, Kaohsiung School of Pharmacy, Kaohsiung Medical University, Kaohsiung Chang Gung University, College of Medicine, Kaohsiung Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi Division of Gastroenterology, Fu-Ying University Hospital, Pin-Tung Divisions of Gastroenterology, Yuan General Hospital, Kaohsiung Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung Division of Gastroenterology; Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi Division of Gastroenterology; Pin-Tung Christian Hospital, Pin-Tung, Taiwan.
Chih-Ming
CM
Liang
Chien-Ning
CN
Hsu
Wei-Chen
WC
Tai
Shih-Cheng
SC
Yang
Cheng-Kun
CK
Wu
Chih-Wei
CW
Shih
Ming-Kun
MK
Ku
Lan-Ting
LT
Yuan
Jiunn-Wei
JW
Wang
Kuo-Lun
KL
Tseng
Wei-Chih
WC
Sun
Tsung-Hsing
TH
Hung
Seng-Howe
SH
Nguang
Pin-I
PI
Hsu
Deng-Chyang
DC
Wu
Seng-Kee
SK
Chuah
D000328:Adult; D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D016558:Hemostasis, Endoscopic; D017721:Hospital Costs; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology; D013624:Taiwan; D055815:Young Adult
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin