Risk Factors for Mortality in Emergently Admitted Patients with Acute Gastric Ulcer: An Analysis of 15,538 Patients in National Inpatient Sample, 2005–2014

Abstract

Background: Patients admitted emergently with a primary diagnosis of acute gastric ulcer have significant complications including morbidity and mortality. The objective of this study was to assess the risk factors of mortality including the role of surgery in gastric ulcers. Methods: Adult (18–64-year-old) and elderly (≥65-year-old) patients admitted emergently with hemorrhagic and/or perforated gastric ulcers, were analyzed using the National Inpatient Sample database, 2005–2014. Demographics, various clinical data, and associated comorbidities were collected. A stratified analysis was combined with a multivariable logistic regression model to assess predictors of mortality. Results: Our study analyzed a total of 15,538 patients, split independently into two age groups: 6338 adult patients and 9200 elderly patients. The mean age (SD) was 50.42 (10.65) in adult males vs. 51.10 (10.35) in adult females (p < 0.05). The mean age (SD) was 76.72 (7.50) in elderly males vs. 79.03 (7.80) in elderly females (p < 0.001). The percentage of total deceased adults was 1.9% and the percentage of total deceased elderly was 3.7%, a difference by a factor of 1.94. Out of 3283 adult patients who underwent surgery, 32.1% had perforated non-hemorrhagic ulcers vs. 1.8% in the non-surgical counterparts (p < 0.001). In the 4181 elderly surgical patients, 18.1% had perforated non-hemorrhagic ulcers vs. 1.2% in the non-surgical counterparts (p < 0.001). In adult patients managed surgically, 2.6% were deceased, while in elderly patients managed surgically, 5.5% were deceased. The mortality of non-surgical counterparts in both age groups were lower (p < 0.001). The multivariable logistic regression model for adult patients electing surgery found delayed surgery, frailty, and the presence of perforations to be the main risk factors for mortality. In the regression model for elderly surgical patients, delayed surgery, frailty, presence of perforations, the male sex, and age were the main risk factors for mortality. In contrast, the regression model for adult patients with no surgery found hospital length of stay to be the main risk factor for mortality, whereas invasive diagnostic procedures were protective. In elderly non-surgical patients, hospital length of stay, presence of perforations, age, and frailty were the main risk factors for mortality, while invasive diagnostic procedures were protective. The following comorbidities were associated with gastric ulcers: alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes, and renal failure. Conclusions: The odds of mortality in emergently admitted geriatric patients with acute gastric ulcer was two times that in adult patients. Surgery was a protective factor for patients admitted emergently with gastric perforated non-hemorrhagic ulcers.

A comparative analysis of Charlson's weighted index of comorbidity and perforated peptic ulcer scores in predicting postoperative mortality and high comprehensive complication index

“…Duration of symptoms and shock on admission have not demonstrated a significant association with mortality (Table 2). Prompt surgery is recommended for those with PPU 19–23 . Delayed surgery beyond 24 h was associated with high mortality 22,23 .…”

“…Prompt surgery is recommended for those with PPU. [19][20][21][22][23] Delayed surgery beyond 24 h was associated with high mortality. 22,23 The current study showed no association between time from door-to-surgery with both mortality and high CCI when operated within 24 h using 6-and 12-h cutoff (Tables 2 and 3).…”

Efek Perasan Rimpang Kunyit (Curcuma longa L.) Terhadap Gambaran Epitel Lambung Mencit yang Diinduksi Indometasin

“…Sebagian besar literatur merujuk bahwa ulkus lambung dan ulkus duodenum berada di dalam satu kesatuan ulkus peptikum meskipun patofisiologi keduanya memiliki perbedaan. Ulkus lambung yang tidak ditangani dapat menyebabkan perforasi pada saluran cerna bagian atas dan berakibat fatal (Idris et al, 2022). Prevalensi ulkus peptikum baik ulkus lambung maupun ulkus duodenum terus mengalami peningkatan baik di Indonesia maupun di dunia.…”

A Meta-Analysis on the Association between Peptic Ulcer Disease and COVID-19 Severity

“…Studies have revealed that the odds of mortality in emergently admitted geriatric patients with acute gastric ulcers were two times higher than in adult patients. The following comorbidities (such as alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes mellitus and renal failure) were reported to be associated with gastric ulcers [ 17 ]. A perforated peptic ulcer is a severe complication of peptic ulcer disease, and individuals with perforated peptic ulcer also have severe abdomen pain with a high risk of long-term illness and fatality [ 18 ].…”