Chronic liver disease and 90‐day mortality in 21 359 patients following peptic ulcer bleeding – a Nationwide Cohort Study

• Published in: Alimentary pharmacology & therapeutics 2015-03, Vol.41 (6), p.564-572
• Main Authors: Holland‐Bill, L., Christiansen, C. F., Gammelager, H., Mortensen, R. N., Pedersen, L., Sørensen, H. T.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Female; Hospitalization - statistics & numerical data; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Diseases - complications; Liver Diseases - mortality; Male; Middle Aged; Peptic Ulcer - complications; Peptic Ulcer - mortality; Peptic Ulcer Hemorrhage - mortality; Prognosis
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13073

Summary Background Bleeding is a serious and frequent complication of peptic ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of peptic ulcer bleeding. However, whether chronic liver disease increases mortality after peptic ulcer bleeding remains unclear. Aim To examine the prognostic impact of chronic liver disease on mortality after peptic ulcer bleeding. Methods We used population‐based medical registries to conduct a cohort study of all Danish residents hospitalised with incident peptic ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non‐cirrhotic chronic liver disease before their admission for peptic ulcer bleeding. We then computed 90‐day mortality after peptic ulcer bleeding based on the Kaplan–Meier method (1 – survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. Results We identified 21 359 patients hospitalised with peptic ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non‐cirrhotic chronic liver disease. Patients with liver cirrhosis and non‐cirrhotic chronic liver disease had a cumulative 90‐day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90‐day MRR of 2.38 (95% CI: 2.02–2.80), compared to 1.49 (95% CI: 1.22–1.83) among patients with non‐cirrhotic chronic liver disease. Conclusion Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for peptic ulcer bleeding compared to patients without chronic liver disease.