Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia: Two nationwide retrospective cohort studies

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Abstract

Introduction The association between thrombocytopenia (TP) and gastrointestinal hemorrhage was not completely understood. The purpose of this study is to evaluate the risk of gastrointestinal hemorrhage and post-hemorrhage mortality in patients with TP. Methods Using the Taiwan National Health Insurance Research Database, we identified 1033 adults aged ≥ 18 years diagnosed with TP in 2000-2003. Non-TP cohort consisted of 10,330 adults randomly selected and matched by age and sex from the same dataset. Incident events of gastrointestinal hemorrhage occurring after TP from January 1, 2000, through December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of gastrointestinal hemorrhage associated with TP were calculated. Another nested cohort study consisted of 27,369 patients with hospitalization due to gastrointestinal hemorrhage between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without TP during admission. Results The incidences of gastrointestinal hemorrhage for people with and without TP were 14.5 and 5.07 per 1000 person-years, respectively (P <0.0001). Compared to people without TP, patients with TP had increased risk of gastrointestinal hemorrhage (HR, 2.61; 95% CI, 2.05-3.32). In the nested cohort study, TP was associated with post-hemorrhage mortality (OR, 1.98; 95% CI, 1.09-3.59). Conclusion Patients with TP showed higher risks of gastrointestinal hemorrhage and post-hemorrhage mortality. Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population.

Original languageEnglish
Pages (from-to)86-90
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume27
DOIs
Publication statusPublished - Jan 1 2016

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Gastrointestinal Hemorrhage
Thrombocytopenia
Cohort Studies
Retrospective Studies
Mortality
Confidence Intervals
Hemorrhage
Odds Ratio
National Health Programs
Taiwan
Hospitalization
Databases

Keywords

  • Cohort study
  • Gastrointestinal hemorrhage
  • Mortality
  • Risk
  • Thrombocytopenia

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{4acfacb6a97640748fbd4e75115dd7e1,
title = "Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia: Two nationwide retrospective cohort studies",
abstract = "Introduction The association between thrombocytopenia (TP) and gastrointestinal hemorrhage was not completely understood. The purpose of this study is to evaluate the risk of gastrointestinal hemorrhage and post-hemorrhage mortality in patients with TP. Methods Using the Taiwan National Health Insurance Research Database, we identified 1033 adults aged ≥ 18 years diagnosed with TP in 2000-2003. Non-TP cohort consisted of 10,330 adults randomly selected and matched by age and sex from the same dataset. Incident events of gastrointestinal hemorrhage occurring after TP from January 1, 2000, through December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95{\%} confidence intervals (CIs) of gastrointestinal hemorrhage associated with TP were calculated. Another nested cohort study consisted of 27,369 patients with hospitalization due to gastrointestinal hemorrhage between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95{\%} CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without TP during admission. Results The incidences of gastrointestinal hemorrhage for people with and without TP were 14.5 and 5.07 per 1000 person-years, respectively (P <0.0001). Compared to people without TP, patients with TP had increased risk of gastrointestinal hemorrhage (HR, 2.61; 95{\%} CI, 2.05-3.32). In the nested cohort study, TP was associated with post-hemorrhage mortality (OR, 1.98; 95{\%} CI, 1.09-3.59). Conclusion Patients with TP showed higher risks of gastrointestinal hemorrhage and post-hemorrhage mortality. Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population.",
keywords = "Cohort study, Gastrointestinal hemorrhage, Mortality, Risk, Thrombocytopenia",
author = "Lo, {Po Han} and Huang, {Yu Feng} and Chuen-Chau Chang and Yeh, {Chun Chieh} and Chang, {Chia Yau} and Yih-Giun Cherng and Ta-Liang Chen and Liao, {Chien Chang}",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/j.ejim.2015.10.007",
language = "English",
volume = "27",
pages = "86--90",
journal = "European Journal of Internal Medicine",
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TY - JOUR

T1 - Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia

T2 - Two nationwide retrospective cohort studies

AU - Lo, Po Han

AU - Huang, Yu Feng

AU - Chang, Chuen-Chau

AU - Yeh, Chun Chieh

AU - Chang, Chia Yau

AU - Cherng, Yih-Giun

AU - Chen, Ta-Liang

AU - Liao, Chien Chang

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Introduction The association between thrombocytopenia (TP) and gastrointestinal hemorrhage was not completely understood. The purpose of this study is to evaluate the risk of gastrointestinal hemorrhage and post-hemorrhage mortality in patients with TP. Methods Using the Taiwan National Health Insurance Research Database, we identified 1033 adults aged ≥ 18 years diagnosed with TP in 2000-2003. Non-TP cohort consisted of 10,330 adults randomly selected and matched by age and sex from the same dataset. Incident events of gastrointestinal hemorrhage occurring after TP from January 1, 2000, through December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of gastrointestinal hemorrhage associated with TP were calculated. Another nested cohort study consisted of 27,369 patients with hospitalization due to gastrointestinal hemorrhage between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without TP during admission. Results The incidences of gastrointestinal hemorrhage for people with and without TP were 14.5 and 5.07 per 1000 person-years, respectively (P <0.0001). Compared to people without TP, patients with TP had increased risk of gastrointestinal hemorrhage (HR, 2.61; 95% CI, 2.05-3.32). In the nested cohort study, TP was associated with post-hemorrhage mortality (OR, 1.98; 95% CI, 1.09-3.59). Conclusion Patients with TP showed higher risks of gastrointestinal hemorrhage and post-hemorrhage mortality. Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population.

AB - Introduction The association between thrombocytopenia (TP) and gastrointestinal hemorrhage was not completely understood. The purpose of this study is to evaluate the risk of gastrointestinal hemorrhage and post-hemorrhage mortality in patients with TP. Methods Using the Taiwan National Health Insurance Research Database, we identified 1033 adults aged ≥ 18 years diagnosed with TP in 2000-2003. Non-TP cohort consisted of 10,330 adults randomly selected and matched by age and sex from the same dataset. Incident events of gastrointestinal hemorrhage occurring after TP from January 1, 2000, through December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of gastrointestinal hemorrhage associated with TP were calculated. Another nested cohort study consisted of 27,369 patients with hospitalization due to gastrointestinal hemorrhage between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without TP during admission. Results The incidences of gastrointestinal hemorrhage for people with and without TP were 14.5 and 5.07 per 1000 person-years, respectively (P <0.0001). Compared to people without TP, patients with TP had increased risk of gastrointestinal hemorrhage (HR, 2.61; 95% CI, 2.05-3.32). In the nested cohort study, TP was associated with post-hemorrhage mortality (OR, 1.98; 95% CI, 1.09-3.59). Conclusion Patients with TP showed higher risks of gastrointestinal hemorrhage and post-hemorrhage mortality. Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population.

KW - Cohort study

KW - Gastrointestinal hemorrhage

KW - Mortality

KW - Risk

KW - Thrombocytopenia

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U2 - 10.1016/j.ejim.2015.10.007

DO - 10.1016/j.ejim.2015.10.007

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VL - 27

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JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

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