INCREASED MORTALITY OF ACUTE UPPER GASTROINTESTINAL-BLEEDING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A CASE-CONTROLLED, MULTIYEAR STUDY OF 53 CONSECUTIVE PATIENTS

The etiology, clinical presentation, and mortality of acute upper gast rointestinal bleeding in patients with chronic obstructive pulmonary d isease (COPD) were analyzed in a case-controlled study of 53 consecuti ve patients admitted from 1985 through 1990 to a university teaching h ospital. The primary controls were 40 consecutive patients with acute upper gastrointestinal bleeding and without COPD admitted from June th rough November 1990 to the same hospital. COPD patients had a signific antly increased mortality from gastrointestinal bleeding as compared t o controls with gastrointestinal bleeding and without COPD (mortality in COPD = 32%, controls = 10%, odds ratio = 4.3, confidence interval o f odds ratio = 1.22-14.8, P < 0.01, Fisher's exact test) and as compar ed to a second control group of 53 consecutive COPD patients without g astrointestinal bleeding (mortality in second controls = 11%, odds rat io = 3.7, confidence interval of odds ratio = 1.25-11.0, P < 0.02, chi square). The study COPD patients had a significantly greater likeliho od of being older, smokers, alcoholics, and taking corticosteroids tha n the primary controls. However, an increased mortality was still pres ent when controlling for these differences by population stratificatio n (eg, mortality in patients greater than or equal to 60 years old: CO PD = 36%, controls = 13%, odds ratio = 4.6, P < 0.05). The two groups had similar mean values of parameters of bleeding severity, such as lo west hematocrit and units of packed erythrocytes transfused. The incre ased mortality was correlated with COPD severity leg, four of five pat ients with prior endotracheal intubation for COPD died, 13 of 48 COPD patients without prior intubation died, odds ratio = 10, P < 0.04, Fis her's exact test). We conclude that COPD patients have increased morta lity associated with gastrointestinal bleeding not accounted for solel y by their unusual demographic features. This finding of a poor progno sis suggests that COPD patients with acute gastrointestinal bleeding s hould be evaluated early for possible intensive care unit admission, e mergency endoscopy, and therapeutic endoscopy or interventional radiol ogy.