Mortality with upper gastrointestinal bleeding and perforation: effects of time and NSAID use.
Mortality with upper gastrointestinal bleeding and perforation: effects of time and NSAID use.
复制标题
DOI：
10.1186/1471-230x-9-41
复制
发表时间：
2009-06-05
影响因子：
2.4
通讯作者：
McQuay HJ
中科院分区：
文献类型：
--
作者：
Straube S;Tramèr MR;Moore RA;Derry S;McQuay HJ
有些人因上消化道出血或穿孔而死亡。 1997 年之前发表的研究估计死亡率为 12%，但需要对最新数据进行系统调查。更好的治疗可能会降低死亡率。死亡率的估计有助于向患者解释治疗的风险，尤其是非甾体抗炎药。对 1997 年之前以及 1997 年至 2008 年之间发表的研究进行的系统回顾。任何研究架构只要报告了因上消化道出血或穿孔的任何原因死亡的病例，都是可以接受的。对所有病例以及服用非甾体抗炎药或阿司匹林的病例分别进行分析。现有 61,067 例病例的信息（81% 自 1997 年以来已公布），其中 5,001 例死亡。所有病例的死亡率均显着下降，从 1997 年之前的研究中的 11.6%（95% 置信区间，11.0 至 12.2）降至 1997 年以来发表的研究中的 7.4%（7.2 至 7.6）。在 5,526 名服用 NSAID 或阿司匹林的患者中，死亡率从 1997 年之前的 14.7%（13.6 至 15.8）上升至自 1997 年以来为 20.9%（18.8 至 22.9）。上消化道出血或穿孔仍然具有有限的死亡风险。研究架构、人群特征、风险因素、死亡率定义和结果报告的差异对效应大小的解释造成了限制。自 1997 年以来公布的数据表明，患有上消化道出血或穿孔的患者总体死亡率已降至十分之一，但接触 NSAID 或阿司匹林的患者死亡率仍然较高，约为五分之一。
Some people who suffer an upper gastrointestinal bleed or perforation die. The mortality rate was estimated at 12% in studies published before 1997, but a systematic survey of more recent data is needed. Better treatment is likely to have reduced mortality. An estimate of mortality is helpful in explaining to patients the risks of therapy, especially with NSAIDs. A systematic review of studies published before 1997, and between 1997 and 2008. Any study architecture was acceptable if it reported on cases who died from any cause of upper gastrointestinal bleed or perforation. Analyses were conducted separately for all cases, and those prescribed NSAID or aspirin. Information was available for 61,067 cases (81% published since 1997) of whom 5,001 died. The mortality rate in all cases fell significantly, from 11.6% (95% confidence interval, 11.0 to 12.2) in pre-1997 studies to 7.4% (7.2 to 7.6) in those published since 1997. In 5,526 patients taking NSAID or aspirin, mortality increased, from 14.7% (13.6 to 15.8) before 1997 to 20.9% (18.8 to 22.9) since 1997. Upper gastrointestinal bleed or perforation still carries a finite risk of death. Differences in study architecture, population characteristics, risk factors, definition of mortality, and reporting of outcomes impose limitations on interpreting effect size. Data published since 1997 suggest that mortality in patients suffering from an upper gastrointestinal bleed or perforation has fallen to 1 in 13 overall, but remains higher at about 1 in 5 in those exposed to NSAID or aspirin.