Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.

<h4>Background</h4>It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed com...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Colin John Crooks, Timothy Richard Card, Joe West
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/d95d6cdc1a4943aca75c60f84607c228
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d95d6cdc1a4943aca75c60f84607c228
record_format	dspace
spelling	oai:doaj.org-article:d95d6cdc1a4943aca75c60f84607c2282021-11-18T05:42:39ZExcess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.1549-12771549-167610.1371/journal.pmed.1001437https://doaj.org/article/d95d6cdc1a4943aca75c60f84607c2282013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23637580/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population.<h4>Methods and findings</h4>Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤ 50 years, 95% CI 3.0%-4.3%) to 15.2% (≥ 80 years, 14.2%-16.3%), representing an excess over controls of between 3.6% (3.0%-4.2%) and 13.4% (12.4%-14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤ 50 years, 3.4%-4.8%) to 46.6% (≥ 80 years, 45.2%-48.1%), representing an excess over controls of between 3.8% (3.1%-4.5%) and 19.0% (17.5%-20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets.<h4>Conclusions</h4>Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co-morbid illness seemingly unrelated to the bleed.Colin John CrooksTimothy Richard CardJoe WestPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 10, Iss 4, p e1001437 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Colin John Crooks Timothy Richard Card Joe West Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
description	<h4>Background</h4>It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population.<h4>Methods and findings</h4>Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤ 50 years, 95% CI 3.0%-4.3%) to 15.2% (≥ 80 years, 14.2%-16.3%), representing an excess over controls of between 3.6% (3.0%-4.2%) and 13.4% (12.4%-14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤ 50 years, 3.4%-4.8%) to 46.6% (≥ 80 years, 45.2%-48.1%), representing an excess over controls of between 3.8% (3.1%-4.5%) and 19.0% (17.5%-20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets.<h4>Conclusions</h4>Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co-morbid illness seemingly unrelated to the bleed.
format	article
author	Colin John Crooks Timothy Richard Card Joe West
author_facet	Colin John Crooks Timothy Richard Card Joe West
author_sort	Colin John Crooks
title	Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
title_short	Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
title_full	Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
title_fullStr	Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
title_full_unstemmed	Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
title_sort	excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/d95d6cdc1a4943aca75c60f84607c228
work_keys_str_mv	AT colinjohncrooks excesslongtermmortalityfollowingnonvaricealuppergastrointestinalbleedingapopulationbasedcohortstudy AT timothyrichardcard excesslongtermmortalityfollowingnonvaricealuppergastrointestinalbleedingapopulationbasedcohortstudy AT joewest excesslongtermmortalityfollowingnonvaricealuppergastrointestinalbleedingapopulationbasedcohortstudy
_version_	1718424820646936576

Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study.

Ejemplares similares