Effect of comorbidity on mortality in patients with peptic ulcer bleeding

Systematic review and meta-analysis

Grigorios I. Leontiadis, Michael Molloy-Bland, Paul Moayyedi, Colin Howden

Research output: Contribution to journalReview article

50 Citations (Scopus)

Abstract

OBJECTIVES:By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB).METHODS:We conducted systematic searches in PubMed and Embase (January 1989-January 2010). Relative risks (RRs) were pooled across selected studies and an analysis of diagnostic test accuracy was performed to validate the results further.RESULTS:Of 1,572 identified studies, 16 were eligible for inclusion. Only three had a low risk of bias and the overall quality of evidence was low. The risk of death (30-day or in-hospital mortality) was significantly greater in PUB patients with comorbidity than in those without (RR: 4.44; 95% confidence interval (CI): 2.45-8.04). The pooled sensitivity for comorbidity predicting death in patients with PUB was 0.86 (95% CI: 0.66-0.95) and the pooled specificity was 0.53 (95% CI: 0.40-0.65). PUB patients with three or more comorbidities had a greater risk of dying than those with one or two (RR: 3.46; 95% CI: 1.34-8.89). All individual comorbidities that we assessed significantly increased the risk of death associated with PUB. However, RRs were higher for hepatic, renal, and malignant disease (range: 4.04-6.33; no significant heterogeneity) than for cardiovascular and respiratory disease and diabetes (2.39, 2.45, and 1.63, respectively; no significant heterogeneity).CONCLUSIONS: Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.

Original languageEnglish (US)
Pages (from-to)331-345
Number of pages15
JournalAmerican Journal of Gastroenterology
Volume108
Issue number3
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

Fingerprint

Peptic Ulcer
Meta-Analysis
Comorbidity
Hemorrhage
Mortality
Confidence Intervals
Hospital Mortality
Routine Diagnostic Tests
PubMed
Cardiovascular Diseases
Kidney
Liver

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Effect of comorbidity on mortality in patients with peptic ulcer bleeding : Systematic review and meta-analysis. / Leontiadis, Grigorios I.; Molloy-Bland, Michael; Moayyedi, Paul; Howden, Colin.

In: American Journal of Gastroenterology, Vol. 108, No. 3, 01.03.2013, p. 331-345.

Research output: Contribution to journalReview article

Leontiadis, Grigorios I. ; Molloy-Bland, Michael ; Moayyedi, Paul ; Howden, Colin. / Effect of comorbidity on mortality in patients with peptic ulcer bleeding : Systematic review and meta-analysis. In: American Journal of Gastroenterology. 2013 ; Vol. 108, No. 3. pp. 331-345.
@article{deadb749773242b396c9d68ac4cbc9a3,
title = "Effect of comorbidity on mortality in patients with peptic ulcer bleeding: Systematic review and meta-analysis",
abstract = "OBJECTIVES:By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB).METHODS:We conducted systematic searches in PubMed and Embase (January 1989-January 2010). Relative risks (RRs) were pooled across selected studies and an analysis of diagnostic test accuracy was performed to validate the results further.RESULTS:Of 1,572 identified studies, 16 were eligible for inclusion. Only three had a low risk of bias and the overall quality of evidence was low. The risk of death (30-day or in-hospital mortality) was significantly greater in PUB patients with comorbidity than in those without (RR: 4.44; 95{\%} confidence interval (CI): 2.45-8.04). The pooled sensitivity for comorbidity predicting death in patients with PUB was 0.86 (95{\%} CI: 0.66-0.95) and the pooled specificity was 0.53 (95{\%} CI: 0.40-0.65). PUB patients with three or more comorbidities had a greater risk of dying than those with one or two (RR: 3.46; 95{\%} CI: 1.34-8.89). All individual comorbidities that we assessed significantly increased the risk of death associated with PUB. However, RRs were higher for hepatic, renal, and malignant disease (range: 4.04-6.33; no significant heterogeneity) than for cardiovascular and respiratory disease and diabetes (2.39, 2.45, and 1.63, respectively; no significant heterogeneity).CONCLUSIONS: Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.",
author = "Leontiadis, {Grigorios I.} and Michael Molloy-Bland and Paul Moayyedi and Colin Howden",
year = "2013",
month = "3",
day = "1",
doi = "10.1038/ajg.2012.451",
language = "English (US)",
volume = "108",
pages = "331--345",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Effect of comorbidity on mortality in patients with peptic ulcer bleeding

T2 - Systematic review and meta-analysis

AU - Leontiadis, Grigorios I.

AU - Molloy-Bland, Michael

AU - Moayyedi, Paul

AU - Howden, Colin

PY - 2013/3/1

Y1 - 2013/3/1

N2 - OBJECTIVES:By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB).METHODS:We conducted systematic searches in PubMed and Embase (January 1989-January 2010). Relative risks (RRs) were pooled across selected studies and an analysis of diagnostic test accuracy was performed to validate the results further.RESULTS:Of 1,572 identified studies, 16 were eligible for inclusion. Only three had a low risk of bias and the overall quality of evidence was low. The risk of death (30-day or in-hospital mortality) was significantly greater in PUB patients with comorbidity than in those without (RR: 4.44; 95% confidence interval (CI): 2.45-8.04). The pooled sensitivity for comorbidity predicting death in patients with PUB was 0.86 (95% CI: 0.66-0.95) and the pooled specificity was 0.53 (95% CI: 0.40-0.65). PUB patients with three or more comorbidities had a greater risk of dying than those with one or two (RR: 3.46; 95% CI: 1.34-8.89). All individual comorbidities that we assessed significantly increased the risk of death associated with PUB. However, RRs were higher for hepatic, renal, and malignant disease (range: 4.04-6.33; no significant heterogeneity) than for cardiovascular and respiratory disease and diabetes (2.39, 2.45, and 1.63, respectively; no significant heterogeneity).CONCLUSIONS: Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.

AB - OBJECTIVES:By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB).METHODS:We conducted systematic searches in PubMed and Embase (January 1989-January 2010). Relative risks (RRs) were pooled across selected studies and an analysis of diagnostic test accuracy was performed to validate the results further.RESULTS:Of 1,572 identified studies, 16 were eligible for inclusion. Only three had a low risk of bias and the overall quality of evidence was low. The risk of death (30-day or in-hospital mortality) was significantly greater in PUB patients with comorbidity than in those without (RR: 4.44; 95% confidence interval (CI): 2.45-8.04). The pooled sensitivity for comorbidity predicting death in patients with PUB was 0.86 (95% CI: 0.66-0.95) and the pooled specificity was 0.53 (95% CI: 0.40-0.65). PUB patients with three or more comorbidities had a greater risk of dying than those with one or two (RR: 3.46; 95% CI: 1.34-8.89). All individual comorbidities that we assessed significantly increased the risk of death associated with PUB. However, RRs were higher for hepatic, renal, and malignant disease (range: 4.04-6.33; no significant heterogeneity) than for cardiovascular and respiratory disease and diabetes (2.39, 2.45, and 1.63, respectively; no significant heterogeneity).CONCLUSIONS: Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.

UR - http://www.scopus.com/inward/record.url?scp=84875213091&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875213091&partnerID=8YFLogxK

U2 - 10.1038/ajg.2012.451

DO - 10.1038/ajg.2012.451

M3 - Review article

VL - 108

SP - 331

EP - 345

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 3

ER -