In-Hospital Mortality Risk Estimation in Single Episodic Upper Gastrointestinal Bleeding Patients Undergoing Hemodialysis: A Retrospective Cohort Study

Shuo-Chun Weng ； Kuo-Hsiung Shu ； Der-Cherng Tarng ； Chi-Hung Cheng ； Cheng-Hsu Chen ； Tung-Min Yu ； Ya-Wen Chuang ； Shih-Ting Huang ； Ming-Ju Wu

《Acta Nephrologica》 26卷3期 (2012/09) Pp. 143-148

https://doi.org/10.6221/AN.2012003

並列摘要

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a major cause of clinical bleeding among patients with end-stage renal disease (ESRD). The purpose of this study was to investigate the association of mortality in uremic patients with single UGIB.METHODS: From 2004 to 2010, a tertiary hospital-based retrospective cohort comprising 244 patients undergoing hemodialysis was investigated. All patients were diagnosed with UGIB according to ICD-9 codes which included peptic ulcer bleeding, duodenal ulcer bleeding, among other symptoms. UGIB was required to be one of the first three discharge diagnoses. Rehospitalization within 3 days after discharge was regarded as the same course. Exclusion criteria were UGI re-bleeding, patients younger than 20 y/o, previous gastric resection or vagotomy, or gastric cancer within the first 2 years of the index hospitalization.RESULTS: The mean age in the group with single UGIB was 71.3 ± 14.7 years. The all-cause mortality was 31.1% (76/244). Using Cox regression models, we found the higher mortality of the single UGIB group was significantly correlated with older age (adjusted hazard ratio [HR] = 1.02, 95% confidence interval [CI] = 1.00-1.04), hepatitis (adjusted HR = 1.96, 95% CI = 1.03-3.71) and albumin ＜ 3 g/dL (adjusted HR = 2.61, 95% CI = 1.44-4.72). Patients with a greater number of infection events during hospitalization were more likely to have poor outcome (crude HR = 1.70, 95% CI = 1.07-2.71). However, after adjustment for covariates, the number of infection episodes was not significantly related to poor outcome.CONCLUSION: In conclusion, single episodic UGIB was correlated with significantly higher mortality in uremic patients during the follow-up. Older age, hepatitis, and albumin ＜ 3 g/dL appeared to worsen all-cause mortality in patients with single UGIB.

並列關鍵字

Albumin ； gastrointestinal ； older age ； uremic

參考文獻

Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol 24: 2-17, 1997.

Lassen A, Hallas J, Schaffalitzky de Muckadell OB. Complicated and uncomplicated peptic ulcers in a Danish county 1993-2002: a population-based cohort study. Am J Gastroenterol 101: 945-953, 2006.

Wong GL, Wong VW, Chan Y, Ching JY, Au K, Hui AJ, et al. High incidence of mortality and recurrent bleeding in patients with Helicobacter pylori-negative idiopathic bleeding ulcers. Gastroen terology 137: 525-531, 2009.

Cheung J, Yu A, LaBossiere J, Zhu Q, Fedorak RN. Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease. Gastrointest Endosc 71: 44-49, 2010.

Chan FK, Leung WK. Peptic-ulcer disease. Lancet 360: 933-941, 2002.