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Impact of Chronic Obstructive Pulmonary Disease on Outcome among Patients with Complicated Peptic Ulcer

¹Department of Clinical Epidemiology, Aarhus University Hospital, Denmark ²Research Unit for General Practice, University of Aarhus, Denmark ³Department of Epidemiology, School of Public Health, Boston University, MA, USA

sc{at}dce.au.dk

Abstract

Background: Chronic obstructive pulmonary disease (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 perforated peptic ulcer. We examined the association between COPD and 30-day mortality following bleeding and perforated peptic ulcer.

Methods: We identified all patients 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 cumulative 30-day mortality rates for ulcer patients with COPD and for other ulcer patients and used regression analysis to obtain 30-day mortality rate ratios (MRR), controlling for potential confounding factors.

Results: Among patients hospitalized with perforated peptic ulcers, 218 (10.7%) had previously been hospitalized with COPD. Thirty-day mortality was 44.0% among perforated ulcer patients with COPD vs. 25.5% among other ulcer patients (adjusted MRR=1.48, 95% CI: 1.18-1.85). Among patients hospitalized with a bleeding peptic ulcer, 759 (10.1%) had previously been admitted with COPD. Thirty-day mortality was 16.5% among bleeding peptic ulcer patients with COPD vs. 10.8% among other ulcer patients (adjusted MRR= 1.38, 95% CI: 1.14-1.68). 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: peptic ulcer haemorrhage • peptic ulcer perforation • COPD • mortality • prognosis • cohort study