Abstract
Although a few studies have investigated the risks of peptic ulcer bleeding (PUB) in cirrhotic patients, large population-based studies on in-hospital and long-term reports on recurrent PUB in a cohort of cirrhotic patients are lacking. This 12-year nationwide cohort study aimed to investigate the risks of in-hospital and long-term rebleeding and mortality in cirrhotic patients and to identify possible risk factors. Patient data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. A total of 15,575 patients who were discharged with a diagnosis of PUB were identified after strict exclusions (n = 2889). Among them, patients with cirrhosis (n = 737) and those with chronic hepatitis (n = 1044) were compared to propensity-score matched normal controls at a ratio of 1:1. Accumulated in-hospital and long-term follow-up PUB-free survival rates were analyzed in patients with cirrhosis, patients with chronic hepatitis, and matched controls. Cox proportional hazards regression was used to identify each independent risk factor. Compared with matched controls, patients with cirrhosis exhibited a 2.62-fold (95% CI: 1.74–3.92) higher risk of developing in-hospital rebleeding, but the risk of long-term rebleeding was comparable between cirrhotic patients and matched controls (hazard ratio: 1.29, 95% CI: 0.8–2.09). On the other hand, no significant difference was observed in in-hospital and long-term rebleeding between chronic hepatitis patients and matched controls. We compared the survival rates of cirrhotic and chronic hepatitis patients to that of matched controls. After propensity score matching, both cirrhotic and chronic hepatitis patients showed significantly lower survival than the matched controls (P < 0.0001 and 0.033, respectively) during the 12-year follow-up period. However, in-hospital and long-term rebleeding rates were not significantly different between chronic hepatitis patients and matched controls (P = 0.251 and 0.474, respectively). In conclusion, liver cirrhosis increased health care expenses in patients with PUB and these patients exhibited higher recurrent bleeding rate than non-cirrhotic patients during hospitalization. Cirrhosis and chronic hepatitis are independently associated with an increased long-term mortality when compared with patients without liver disease.
Highlights
Peptic ulcer bleeding (PUB) is an important cause of hospitalization worldwide [1, 2]
No long-term follow-up studies of a large cohort of patients have been conducted to evaluate the occurrence of recurrent PUB and mortality in cirrhotic patients after discharge
Few studies have compared the outcomes among patients with cirrhosis or chronic hepatitis and patients without liver disease
Summary
Peptic ulcer bleeding (PUB) is an important cause of hospitalization worldwide [1, 2]. Occurrence of peptic ulcers in patients with liver cirrhosis can become a serious problem. PUB accounts for 30%–40% of nonvariceal UGI bleeding in cirrhotic patients [3]. Cirrhotic patients in clinical practice are associated with more frequent PUB and have higher mortality rates than those without cirrhosis when they bleed [4,5,6,7]. 15% of patients with cirrhosis die within 6 weeks after nonvariceal UGI bleeding [7]. Large population-based studies on in-hospital and long-term reports on recurrent PUB and mortality in a cohort of cirrhotic patients are lacking. This 12-year nationwide cohort study aimed to investigate the risks of in-hospital and long-term rebleeding and mortality in cirrhotic patients and to identify possible risk factors
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