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Diabetes and 30-Day Mortality From Peptic Ulcer Bleeding and Perforation

A Danish population-based cohort study

¹ Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark
² Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
³ Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts

Address correspondence and reprint requests to Reimar Wernich Thomsen, MD, PhD, Department of Clinical Epidemiology, Aarhus University Hospital, Forskningens Hus, Sdr. Skovvej 15, Postbox 365, DK-9100 Aalborg, Denmark. E-mail: uxreth{at}aas.nja.dk

OBJECTIVE— Diabetes may influence the outcome of complicated peptic ulcer disease, due to angiopathy, blurring of symptoms, and increased risk of sepsis. We examined whether diabetes increased 30-day mortality among Danish patients hospitalized with bleeding or perforated peptic ulcers.

RESEARCH DESIGN AND METHODS— This population-based cohort study took place in the three Danish counties of North Jutland, Viborg, and Aarhus between 1991 and 2003. Patients hospitalized with a first-time diagnosis of peptic ulcer bleeding or perforation were identified using the counties’ hospital discharge registries. Data on diabetes, other comorbidities, and use of ulcer-associated drugs were obtained from discharge registries and prescription databases. The Danish Civil Registry System allowed complete follow-up for mortality. The outcome under study was 30-day mortality in diabetic versus nondiabetic patients, adjusted for potential confounders.

RESULTS— We identified 7,232 patients hospitalized for bleeding ulcers, of whom 731 (10.1%) had diabetes. The 30-day mortality among diabetic patients was 16.6 vs. 10.1% for other patients with bleeding ulcers. The adjusted 30-day mortality rate ratio (MRR) for diabetic patients was 1.40 (95% CI 1.15–1.70). We also identified 2,061 patients with perforated ulcers, of whom 140 (6.8%) had diabetes. The 30-day mortality among diabetic patients was 42.9 vs. 24.0% in other patients with perforated ulcers, corresponding to an adjusted 30-day MRR of 1.51 (1.15–1.98).

CONCLUSIONS— Among patients with peptic ulcer bleeding and perforation, diabetes appears to be associated with substantially increased short-term mortality.

Abbreviations: MRR, mortality rate ratio

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