NSAIDs increase mortality after peptic ulcer perforation

Use of NSAIDs, including COX-2 inhibitors, is associated with a poor prognosis in peptic ulcer perforation, finds December's American Journal of Gastroenterology.

Nonsteroidal anti-inflammatory drug (NSAID) use is a strong risk factor for peptic ulcer perforation.

However, little is known about the outcome of this condition among NSAID users.

Dr Reimar Thomsen and colleagues from Denmark examined 30-day mortality after peptic ulcer perforation associated with the use of traditional NSAIDs.

The research team also assessed the association between peptic ulcer perforation and newer selective cyclo-oxygenase-2 (COX-2) inhibitors.

The researchers conducted a cohort study of patients with the first hospitalization for peptic ulcer perforation.

30-day mortality was 35% among current NSAID users

American Journal of Gastroenterology

The patients were identified in discharge registries of 3 Danish counties between 1991 and 2003.

Data on preadmission NSAID use, other ulcer-related drugs, and comorbidity were likewise from population-based registries.

The researchers ascertained mortality from the Civil Registration System.

The team compared 30-day mortality in NSAID users and nonusers.

The researchers adjusted for age, gender, comorbidity, previous uncomplicated peptic ulcer, and ulcer medication use.

Of the 2,061 patients hospitalized with peptic ulcer perforation, 38% were current NSAID users.

The team observed that the 30-day mortality was 25% overall, and 35% among current NSAID users.

Compared with never-use, the adjusted 30-day mortality rate ratios were 1.8 for current use of NSAIDs alone.

For current use combined with other ulcer-associated drugs, the adjusted 30-day mortality rate ratio was 1.6.

The team found that the mortality increase associated with the use of COX-2 inhibitors was similar to that of traditional NSAIDs.

The adjusted mortality rate ratios for users of COX-2 inhibitors alone and in combination were 2 and 1.4, respectively.

The researchers noted that for users of traditional NSAIDs alone or in combination, the adjusted mortality rate ratios were 1.7 and 1.6.

Dr Thomsen's team concludes, “Current use of NSAIDs, including COX-2 inhibitors, is associated with a poor prognosis for patients hospitalized with peptic ulcer perforation.”