Increased mortality with peptic ulcer bleeding in patients with both compensated and decompensated cirrhosis

• Published in: Gastrointestinal endoscopy 2014-04, Vol.79 (4), p.605-614.e3
• Main Authors: Venkatesh, Preethi G.K., MD, Parasa, Sravanthi, MD, Njei, Basile, MD, MPH, Sanaka, Madhusudhan R., MD, Navaneethan, Udayakumar, MD
• Format: Article
• Language: English
• Subjects: Aged; Costs and Cost Analysis; Cross-Sectional Studies; Female; Gastroenterology and Hepatology; Hospital Mortality; Hospitalization - economics; Humans; Length of Stay; Liver Cirrhosis - complications; Liver Cirrhosis - economics; Liver Cirrhosis - surgery; Male; Middle Aged; Peptic Ulcer Hemorrhage - complications; Peptic Ulcer Hemorrhage - economics; Peptic Ulcer Hemorrhage - mortality; Peptic Ulcer Hemorrhage - surgery; Retrospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.08.026

Background Cirrhosis is associated with worse outcomes in peptic ulcer bleeding (PUB). There are no population-based studies from the United States on the impact of cirrhosis on PUB outcomes. Objective To investigate the impact of cirrhosis on outcomes of patients with PUB. Design Cross-sectional study. Setting Nationwide Inpatient Sample 2009. Patients International Classification of Diseases, the 9th revision, codes were used to identify patients with PUB and cirrhosis. The control group was patients with PUB without cirrhosis. Main Outcome Measurements In-hospital mortality, length of stay, and hospitalization costs. Results A total of 96,887 discharges with PUB as a diagnosis were identified—3574 with PUB and cirrhosis and 93,313 with PUB alone without cirrhosis. Mortality of PUB with concomitant cirrhosis was higher than in the control group without cirrhosis (5.5% vs 2%; P  = .01); decompensated cirrhosis had higher mortality than did compensated cirrhosis (6.6% vs 3.9%; P  = .01). In multivariate analysis, the presence of cirrhosis independently increased mortality (adjusted odds ratio (aOR) 3.3; 95% confidence interval [CI], 2.2-4.9). Stratified analysis showed that decompensated cirrhosis (aOR 4.4; 95% CI, 2.6-7.3) had higher mortality than compensated cirrhosis (aOR 1.9; 95% CI, 1.04-3.6). There was no difference in the proportion of patients who underwent endoscopy within 24 hours (51.9% vs 51.1%; P  = .68) between those with cirrhosis and controls. Patients with cirrhosis received less surgical intervention (aOR 0.8; 95% CI, 0.6-0.9) compared with controls. Hospitalization costs also were increased in patients with decompensated cirrhosis. Limitations Administrative data set. Conclusion Both decompensated and compensated cirrhosis are associated with increased mortality in patients with PUB.