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Impact of COPD on Outcome Among Patients With Complicated Peptic Ulcer^*

^* From the Department of Clinical Epidemiology (Drs. Christensen, Thomsen, Nørgaard, and Sørensen, and Mr. Riis), Aarhus University Hospital, Aarhus, Denmark; and Research Unit for General Practice (Ms. Tørring), University of Aarhus, Aarhus, Denmark.

Correspondence to: Steffen Christensen, MD, Department of Clinical Epidemiology, Aarhus University Hospital, Ole Worms Alle 150, DK-8000 Aarhus C, Denmark; e-mail: sc{at}dce.au.dk

Abstract

Background: COPD is associated with an increased risk of peptic ulcer disease, but limited data exist on whether COPD influences short-term mortality among patients with bleeding and a perforated peptic ulcer. We examined the association between COPD and 30-day mortality following bleeding and perforation of a peptic ulcer.

Methods: We identified all patients who had been hospitalized with a first-time diagnosis of peptic ulcer perforation (n = 2,033) or bleeding (n = 7,486) in northern Denmark between 1991 and 2004. Information on COPD, comorbidities, and filled prescriptions was obtained from medical databases. Mortality was ascertained using the Danish Civil Registration System. We computed the cumulative 30-day mortality rates for ulcer patients with COPD and for other ulcer patients, and used regression analysis to obtain the 30-day mortality rate ratios (MRRs), controlling for potential confounding factors.

Results: Among patients who were hospitalized with perforated peptic ulcers, 218 (10.7%) had previously been hospitalized with COPD. The 30-day mortality rate was 44.0% among perforated ulcer patients with COPD vs 25.5% among other ulcer patients (adjusted MRR, 1.48; 95% confidence interval [CI], 1.18 to 1.85). Among patients hospitalized with a bleeding peptic ulcer, 759 (10.1%) had previously been hospitalized with COPD. The 30-day mortality rate was 16.5% among bleeding peptic ulcer patients with COPD vs 10.8% among other ulcer patients (adjusted MRR, 1.38; 95% CI, 1.14 to 1.68). The use of oral glucocorticoids among COPD patients was associated with higher MRRs for both perforated and bleeding peptic ulcers.

Conclusions: COPD substantially increased 30-day mortality among patients with bleeding and perforated peptic ulcers.

Key Words: cohort study • COPD • mortality • peptic ulcer hemorrhage • peptic ulcer perforation • prognosis