Document Detail


Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis.
MedLine Citation:
PMID:  20236256     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent data associated higher mortality with medical rather than surgical intervention in patients with ulcerative colitis who require hospitalization.
AIM: To examine factors influencing UC-related mortality in Scotland.
METHOD: Using the national record linkage database 1998-2000, 3-year mortality was determined after four admission types: colectomy-elective or emergency; no colectomy-elective or emergency.
RESULTS: Of 1078 patients, crude 3-year mortality rates were: colectomy elective 5.6% (n = 177) and emergency 9.0% (100); no colectomy elective 9.8% (244) and emergency 16.0% (557). Using elective colectomy as reference, multivariate analysis [OR (95% CI)] showed that admission age >50 years [OR 5.46 (2.29-11.95)], male gender [OR 1.92 (1.23-3.02)], comorbidity [OR 2.2 (1.38-3.51)], length of stay >15 days [OR 2.04 (1.08-3.84)] and prior IBD admission [OR 1.66 (1.06-2.61)] were independently related to mortality. Age was the strongest determinant. No patient <30 years died. Mortality of patients aged <50 years [10/587 (1.7%)] was significantly lower than mortality of those aged 50-64 years [26/246 (10.6%)] (chi(2) = 32.91; P < 0.0000001) and >65 [96/245 (39.2%)] (chi(2) = 218.2; P < 0.0000001). For those patients aged more than 65 years, mortality in the four groups was 29.4%, 33.3%, 28.1% and 44.7%- all greater than expected in the Scottish population on assessment of standardized mortality ratios.
CONCLUSION: Hospital admission in UC patients >65 is associated with high mortality. Management strategies should consider this by treatment in specialist units, early investigation, focused medical treatment and earlier surgical referral.
Authors:
R J Nicholls; D N Clark; L Kelso; A M Crowe; A D Knight; P Hodgkins; J Satsangi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-17
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  31     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-08     Completed Date:  2011-01-05     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1310-21     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors*
Colectomy / mortality*
Colitis, Ulcerative / mortality*,  surgery
Comorbidity
Female
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Risk Factors
Scotland / epidemiology
Grant Support
ID/Acronym/Agency:
CZB/4/540//Chief Scientist Office; ETM/137//Chief Scientist Office; ETM/75//Chief Scientist Office; G0600329//Medical Research Council; G0800759//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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