Perforated peptic ulcer: use of pre-admission oral glucocorticoids and 30-day mortality

Background Despite evidence that use of glucocorticoids increases the risk of complicated peptic ulcer disease, limited data exist on how use of oral glucocorticoids affects outcome for patients with peptic ulcer perforation. Aim To examine 30-day mortality from peptic ulcer perforation among pre-admission oral glucocorticoid users compared with non-users. Methods We identified 2061 patients with a first-time hospital discharge diagnosis of perforated peptic ulcer, using population-based discharge registries in three Danish counties. Data on use of glucocorticoids and other ulcer-related drugs, previous hospitalizations for uncomplicated peptic ulcer disease, and comorbidity were obtained from discharge registries and prescription databases. Follow-up data on mortality were provided by the Danish Civil Registry System. Results A total of 228 patients (11.1%) were exposed to glucocorticoids within 60 days of admission. Overall 30-day mortality rate was 25.2%, the corresponding rate among current glucocorticoid users was 39.4%. Compared with 'never users', the adjusted mortality ratio among current users of oral glucocorticoids alone was 2.1 (95% CI: 1.5-3.1). Among current users of oral glucocorticoids in combination with other ulcer-related drugs the mortality ratio was 1.5 (950/6 CI: 1.1-2.1). Conclusion Pre-admission use of oral glucocorticoids is associated with up to a twofold increase in 30-day mortality among patients hospitalized with perforated peptic ulcer.