Laursen Stig Borbjerg, Hansen Jane Møller, Hallas Jesper, Schaffalitzky de Muckadell Ove B
Department of Medical Gastroenterology, Odense University Hospital , Odense C , Denmark.
Scand J Gastroenterol. 2015 Feb;50(2):145-52. doi: 10.3109/00365521.2014.992365. Epub 2014 Dec 26.
Previous studies have concluded that peptic ulcer bleeding (PUB) is associated with increased long-term mortality. The underlying mechanism of this excess mortality is poorly understood. The aim of the present study was to examine if PUB patients have an increased long-term mortality compared to a matched control group when adjusting for comorbidity and socioeconomic status. Additionally, we identified predictive factors for mortality and examined causes of death.
We performed an observational study, comparing consecutive patients admitted with PUB with a matched control cohort from the source population. Predictors of mortality were identified using proportional hazards models. Causes of death were retrieved from death certificates. Long-term mortality was analyzed with adjustment for Charlson comorbidity index (CCI) and average income in residence municipality using proportional hazards models.
We included 455 PUB cases and 2224 control subjects. Median follow up was 9.7 years, and median survival for the PUB and control cohorts was 7 and 12 years, respectively (p < 0.001). PUB patients had a higher level of comorbidity (mean CCI: 0.92 vs. 0.49; p < 0.0001). After adjustments, PUB patients had an excess mortality lasting at least 10 years after presentation. Age, comorbidity, male sex, anemia, and smoking were predictors for long-term mortality. The distribution of causes of death was similar in the two cohorts.
PUB patients have an increased long-term mortality that is explained by nonspecific comorbidity.
既往研究得出结论，消化性溃疡出血（PUB）与长期死亡率增加相关。这种额外死亡率的潜在机制尚不清楚。本研究的目的是在调整合并症和社会经济地位后，检查PUB患者与匹配对照组相比是否具有更高的长期死亡率。此外，我们确定了死亡率的预测因素并检查了死因。
我们进行了一项观察性研究，将连续收治的PUB患者与来自源人群的匹配对照队列进行比较。使用比例风险模型确定死亡率的预测因素。从死亡证明中获取死因。使用比例风险模型对长期死亡率进行分析，并调整Charlson合并症指数（CCI）和居住市的平均收入。
我们纳入了455例PUB病例和2224例对照对象。中位随访时间为9.7年，PUB队列和对照队列的中位生存期分别为7年和12年（p<0.001）。PUB患者的合并症水平更高（平均CCI：0.92对0.49；p<0.0001）。调整后，PUB患者在就诊后至少10年内存在额外死亡率。年龄、合并症、男性、贫血和吸烟是长期死亡率的预测因素。两个队列的死因分布相似。
PUB患者的长期死亡率增加，这可由非特异性合并症解释。
