One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable

Table 1 “High risk” group selection

	Non-selective NSAID users	COX-2 inhibitor users	Anti-platelet users
Past history of PUD	Y	Y	Y
Concurrent antiplatelet or anticoagulant therapy	Y	Y	Y
Concurrent corticosteroid therapy	Y
Age ≥ 60 yr	Y
Both: Age ≥ 60 yr and concurrent corticosteroids	Y		Y
High dose, duration > 2 wk	Y

Patients were considered as high risk according to guidelines [use of non-steroidal anti-inflammatory drug (NSAIDs), cyclooxygenase-2 (COX-2) inhibitor and/or anti-platelet agents in addition to features as listed in the first column; Y: High risk group; PUD: Peptic ulcer disease.

Table 2 Baseline patient characteristics n (%)

Characteristics	Total	Patients
		(n = 507)
Demographic	Age > 65 yr	335 (66)
	Male	313 (62)
Medication use	Aspirin	239 (47)
	NSAIDS	124 (24)
	Anticoagulant	71 (14)
	Clopidogrel	70 (14)
	Corticosteroids	46 (9)
Comorbidity	Ischaemic heart disease	150 (30)
	Diabetes	114 (22)
	Atrial fibrillation	72 (14)
	Renal failure	66 (13)
	Cerebrovascular disease	58 (11)
	Malignancy	51 (10)
	Chronic obstructive pulmonary disease	40 (8)
	Cirrhosis	20 (4)
	Haematological malignancy	14 (3)
	Aortic stenosis	9 (2)

NSAIDS: Non-steroidal anti-inflammatory drug.

Table 3 Comparison of outcomes during hospitalization for patients classified as “high risk” with those “not high risk” according to concurrent medication use (see text) n (%)

	High Risk	Not High Risk	P value
	(n = 174)	(n = 333)
Median Rockall Score (IQR)
Pre-endoscopic	3 (2-4)	3 (1-4)	< 0.0011
Complete	5 (4-6)	4 (3-6)	0.0021
Median packed red cells units transfused (IQR)	3 (1-4)	2 (0-4)	0.1941
Median length of stay in days (IQR)	5 (3-10)	4 (3-7)	0.0431
Rebleeding	13 (7.5)	42 (12.6)	0.0772
Need for surgery	4 (2.3)	17 (5.1)	0.1322
In-hospital mortality	1 (0.6)3	13 (3.9)4	0.0302

¹Mann-Whitney test;

²χ² test;

³Cause of death: uncontrolled bleeding (1);

⁴Cause of death: Decompensated heart failure (1), acute myocardial infarction (2), advanced malignancy (5), decompensated cirrhosis (1), hospital acquired pneumonia (1), uncontrolled bleeding (1), uncertain from case notes (2). IQR: Interquartile range.

Table 4 Comparison of outcomes during hospitalization in high risk patients according to the use of gastroprotection vs no gastroprotection n (%)

	Gastroprotection (n = 44)	No gastroprotection (n = 130)	P value
Median Rockall Score (IQR)
	Pre-endoscopic	3 (3-4)	3 (2-4)	0.351
Complete	5 (4-6)	5 (3-6)	0.581
Median packed red cells units transfused (IQR)	3 (2-4)	3 (1-4)	0.811
Median length of stay in d (IQR)	5 (3-11)	5 (3-8)	0.821
Rebleeding	5 (11.4)	8 (6.2)	0.312
Need for surgery	1 (2.3)	3 (2.3)	1.02
In-hospital mortality	0 (0)	1 (0.8)3	1.02

There were no significant differences for any variables between the 2 groups.

¹Mann-Whitney;

²Fisher’s Exact test;

³Cause of death: uncontrolled bleeding (1). IQR: Interquartile range.