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Abstract
Background: Upper gastrointestinal bleeding (UGIB) is a major cause of clinical bleeding among patients with end-stage renal disease (ESRD). This study aimed to investigate the association between mortality and UGIB in patients with uremia. Methods: From 2004 to 2010, a tertiary hospital-based retrospective cohort comprising 322 patients undergoing hemodialysis was investigated. All the patients were diagnosed with UGIB according to the International Classification of Diseases, 9th Revision (ICD-9) that included peptic ulcer bleeding, duodenal ulcer bleeding, and other symptoms. UGIB was required to be one of the first three discharge diagnoses. Rehospitalization within 3 days after discharge was regarded as the same course. Exclusion criteria were age <20 years, previous gastric resection or vagotomy, esophageal and gastric variceal bleeding, or gastric cancer within the first 2 years of the index hospitalization. Results: The all-cause in-hospital mortality rate of patients with UGIB undergoing hemodialysis was high, with the first-month mortality rate of 13.7%, sixth-month mortality rate of 26.7%, and first-year mortality rate of 27.0%. Using Cox regression models, we found that the high mortality rate of the UGIB group was significantly correlated with older age [adjusted hazard ratio (HR) = 1.02, 95% confidence interval (CI) = 1.01–1.04], female sex (adjusted HR = 1.62, 95% CI = 1.05–2.51), infection during hospitalization (adjusted HR = 1.85, 95% CI = 1.13–3.03), single episodic UGIB (adjusted HR = 2.00, 95% CI = 1.08–3.70), abnormal white blood cell (WBC) count (adjusted HR = 1.59, 95% CI = 1.03–2.45), and albumin level ≤3 g/dL (adjusted HR = 2.67, 95% CI = 1.51–4.72). Conclusion: In conclusion, patients with ESRD who are admitted with primary UGIB have a profoundly increased risk of all-cause in-hospital mortality during the follow-up period.
ACKNOWLEDGMENTS
The authors are grateful to the Clinical Informatics Research and Development Center and the Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C., for its assistance.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
The authors thank the Taichung Veterans General Hospital, Taiwan, R.O.C., for providing the grants (TCVGH-1003606A and TCVGH-1013602A) for this study.