Lin S-C, Wu K-L, Chiu K-W, Lee C-T, Chiu Y-C, Chou Y-P, Hu M-L, Tai W-C, Chiou S-S, Hu T-H, Changchien C-S, Chuah S-K
Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Clin Pract. 2012 Aug;66(8):774-781. doi: 10.1111/j.1742-1241.2012.02974.x. Epub 2012 Jun 1.
Background and Aims: Patients suffering from peptic ulcer (PU) bleeding who have end-stage renal disease (ESRD) may encounter more adverse outcomes. The primary objective is to investigate the risk factors that influence the outcomes of ESRD and chronic kidney disease (CKD) patients with PU bleeding after successful initial endoscopic haemostasis. Methods: A total of 540 patients with PU bleeding after initial endoscopic haemostasis in a tertiary hospital were investigated retrospectively. They were sorted into three groups after randomised age-matched adjustment: ESRD group (n = 90), CKD group (n = 90) and control group (n = 360). Main outcome measurements were rebleeding, requirement for blood transfusion and surgery, length of hospital stay and mortality. Results: The rebleeding rates were 43% for the ESRD group vs. 21% for the CKD group vs. 12% for the control group (overall p = < 0.001). Multivariate analysis showed the predictors of rebleeding were ESRD, time to endoscope, and non-high-dose proton-pump inhibitors (PPI) users. The risk factors for bleeding-related mortality were presence of moderate degree of CKD and ESRD group, time to endoscope, and Rockall score. All-cause mortality was related to presence of moderate degree of CKD and ESRD group, platelet count, time to endoscope, Rockall score and length of hospital stay. Conclusions: ESRD patients who suffered from PU bleeding were at risk of excessive rebleeding and mortality with frequent occurrence of delayed rebleeding. This study suggests that early endoscopy for initial haemostasis and high-dose intravenous PPI are associated with the reduction of rebleeding risk especially in patients with high Rockall scores.
患有消化性溃疡（PU）出血且患有终末期肾病（ESRD）的患者可能会面临更多不良后果。主要目的是调查影响ESRD和慢性肾脏病（CKD）合并PU出血患者在初次内镜止血成功后的预后的危险因素。方法：回顾性调查了一家三级医院中540例初次内镜止血后发生PU出血的患者。在按年龄匹配进行随机调整后，将他们分为三组：ESRD组（n = 90）、CKD组（n = 90）和对照组（n = 360）。主要观察指标为再出血、输血和手术需求、住院时间和死亡率。结果：ESRD组的再出血率为43%，CKD组为21%，对照组为12%（总体p = < 0.001）。多变量分析显示，再出血的预测因素为ESRD、内镜检查时间以及非高剂量质子泵抑制剂（PPI）使用者。出血相关死亡率的危险因素为中度CKD和ESRD组的存在、内镜检查时间以及Rockall评分。全因死亡率与中度CKD和ESRD组的存在、血小板计数、内镜检查时间、Rockall评分和住院时间有关。结论：患有PU出血的ESRD患者有再出血过多和死亡的风险，且延迟再出血频繁发生。本研究表明，早期内镜进行初次止血和高剂量静脉注射PPI与降低再出血风险相关，尤其是在Rockall评分高的患者中。
