Division of Epidemiology and Public Health, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom.
PLoS Med. 2013;10(4):e1001437. doi: 10.1371/journal.pmed.1001437. Epub 2013 Apr 30.
It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population.
Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤ 50 years, 95% CI 3.0%-4.3%) to 15.2% (≥ 80 years, 14.2%-16.3%), representing an excess over controls of between 3.6% (3.0%-4.2%) and 13.4% (12.4%-14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤ 50 years, 3.4%-4.8%) to 46.6% (≥ 80 years, 45.2%-48.1%), representing an excess over controls of between 3.8% (3.1%-4.5%) and 19.0% (17.5%-20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets.
Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co-morbid illness seemingly unrelated to the bleed.
上消化道出血是孤立的胃肠道事件还是患者整体健康状况恶化的指标尚不清楚。因此，我们研究了与非静脉曲张性出血相比，个体在出血后过量死亡的原因，并与一般人群中的死亡匹配样本进行了比较。
使用来自英国医院发病统计数据（HES）、普通实践研究数据库（GPRD）和国家统计局死亡登记处的纵向链接数据，定义了 1997 年至 2010 年之间的非静脉曲张性出血队列。对照在研究开始时通过年龄、性别、实践和年份进行匹配。然后使用累积发生率函数，在考虑竞争风险的情况下计算出血后 5 年内每种死因的超额风险。共有 16355 名非静脉曲张性上消化道出血患者与 81523 名对照相匹配。因胃肠道原因（恶性或非恶性）导致的 5 年总死亡风险范围为 3.6%（≤50 岁，95%CI 3.0%-4.3%）至 15.2%（≥80 岁，14.2%-16.3%），与对照组相比，超额风险分别为 3.6%（3.0%-4.2%）和 13.4%（12.4%-14.5%）。相比之下，非胃肠道原因导致的 5 年总死亡风险范围为 4.1%（≤50 岁，3.4%-4.8%）至 46.6%（≥80 岁，45.2%-48.1%），与对照组相比，超额风险分别为 3.8%（3.1%-4.5%）和 19.0%（17.5%-20.6%）。本研究的主要局限性是暴露和结局的潜在分类错误；然而，我们试图通过使用多个链接数据集衍生的信息来尽量减少这种错误。
与匹配对照相比，上消化道出血后所有原因导致的死亡均增加，死亡风险的一半以上归因于看似无关的合并症。因此，非静脉曲张性出血可能需要仔细评估与出血无关的合并症。
