Increased mortality of acute upper gastrointestinal bleeding in patients with chronic obstructive pulmonary disease

The etiology, clinical presentation, and mortality of acute upper gastrointestinal bleeding in patients with chronic obstructive pulmonary disease (COPD) were analyzed in a case-controlled study of 53 consecutive patients admitted from 1985 through 1990 to a university teaching hospital. The primary controls were 40 consecutive patients with acute upper gastrointestinal bleeding and without COPD admitted from June through November 1990 to the same hospital. COPD patients had a significantly increased mortality from gastrointestinal bleeding as compared to controls with gastrointestinal bleeding and without COPD (mortality in COPD=32%, controls=10%, odds ratio=4.3, confidence interval of odds ratio=1.22–14.8,P<0.01, fisher's=" exact=" test)=" and=" as=" compared=" to=" a=" second=" control=" group=" of=" 53=" consecutive=" copd=" patients=" without=" gastrointestinal=" bleeding=" (mortality=" in=" second=" controls="11%," odds=" ratio="3.7," confidence=" interval=" of=" odds=" ratio=">P<0.02, chi=" square).=" the=" study=" copd=" patients=" had=" a=" significantly=" greater=" likelihood=" of=" being=" older,=" smokers,=" alcoholics,=" and=" taking=" corticosteroids=" than=" the=" primary=" controls.=" however,=" an=" increased=" mortality=" was=" still=" present=" when=" controlling=" for=" these=" differences=" by=" population=" stratification=" (eg,=" mortality=" in=" patients=">60 years old: COPD=36%, controls=13%, odds ratio=4.6,P<0.05). the=" two=" groups=" had=" similar=" mean=" values=" of=" parameters=" of=" bleeding=" severity,=" such=" as=" lowest=" hematocrit=" and=" units=" of=" packed=" erythrocytes=" transfused.=" the=" increased=" mortality=" was=" correlated=" with=" copd=" severity=" (eg,=" four=" of=" five=" patients=" with=" prior=" endotracheal=" intubation=" for=" copd=" died,=" 13=" of=" 48=" copd=" patients=" without=" prior=" intubation=" died,=" odds=" ratio=">P<0.04, fisher's=" exact=" test).=" we=" conclude=" that=" copd=" patients=" have=" increased=" mortality=" associated=" with=" gastrointestinal=" bleeding=" not=" accounted=" for=" solely=" by=" their=" unusual=" demographic=" features.=" this=" finding=" of=" a=" poor=" prognosis=" suggests=" that=" copd=" patients=" with=" acute=" gastrointestinal=" bleeding=" should=" be=" evaluated=" early=" for=" possible=" intensive=" care=" unit=" admission,=" emergency=" endoscopy,=" and=" therapeutic=" endoscopy=" or=" interventional=">Presented at the 1994 annual meeting of the American Gastro-enterology Association.