頁籤選單縮合
題 名 | In-Hospital Mortality Risk Estimation in Single Episodic Upper Gastrointestinal Bleeding Patients Undergoing Hemodialysis: A Retrospective Cohort Study |
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作 者 | Weng, Shuo-chun; Shu, Kuo-hsiung; Tarng, Der-cherng; Cheng, Chi-hung; Chen, Cheng-hsu; Yu, Tung-min; Chuang, Ya-wen; Huang, Shih-ting; Wu, Ming-ju; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 26:3 2012.09[民101.09] |
頁 次 | 頁143-148 |
分類號 | 415.816 |
關鍵詞 | Albumin; Gastrointestinal; Older age; Uremic; |
語 文 | 英文(English) |
英文摘要 | BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a major cause of clinical bleeding among patients with end-stage renal disease (ESRD). The purpose of this study was to investigate the association of mortality in uremic patients with single UGIB. METHODS: From 2004 to 2010, a tertiary hospital-based retrospective cohort comprising 244 patients undergoing hemodialysis was investigated. All patients were diagnosed with UGIB according to ICD-9 codes which included peptic ulcer bleeding, duodenal ulcer bleeding, among 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 UGI re-bleeding, patients younger than 20 y/o, previous gastric resection or vagotomy, or gastric cancer within the first 2 years of the index hospitalization. RESULTS: The mean age in the group with single UGIB was 71.3 ± 14.7 years. The all-cause mortality was 31.1% (76/244). Using Cox regression models, we found the higher mortality of the single UGIB group was significantly correlated with older age (adjusted hazard ratio [HR] = 1.02, 95% confidence interval [CI] = 1.00-1.04), hepatitis (adjusted HR = 1.96, 95% CI = 1.03-3.71) and albumin < 3 g/dL (adjusted HR = 2.61, 95% CI = 1.44-4.72). Patients with a greater number of infection events during hospitalization were more likely to have poor outcome (crude HR = 1.70, 95% CI = 1.07-2.71). However, after adjustment for covariates, the number of infection episodes was not significantly related to poor outcome. CONCLUSION: In conclusion, single episodic UGIB was correlated with significantly higher mortality in uremic patients during the follow-up. Older age, hepatitis, and albumin < 3 g/dL appeared to worsen all-cause mortality in patients with single UGIB. |
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