Higher Risk of Developing Peptic Ulcer Bleeding in Adult Patients Diagnosed with Hypoalbuminemia

Aim: To evaluate whether patients diagnosed with hypoalbuminemia have higher risk of developing peptic ulcer bleeding (PUB). Background: Low serum albumin levels are particularly common in critically ill patients. Life-threatening upper gastrointestinal (UGI) hemorrhage is a stress-related mucosal injury or stress ulceration in critically ill patients. Patients and methods: We conducted a retrospective cohort study from the 2000–2010 database records of Taiwan’s Bureau of National Health Insurance. Hypoalbuminemia patients were defined at least one of the inpatient claims with a diagnosis defined using ICD-9-CM diagnosis code: 273.8. To be defined as a non-hypoalbuminemic, a person cannot have the code ICD-9-CM: 273.8 in their inpatient records or in the ambulatory care claims. The primary endpoint was hospitalization for PUB. We used a Cox’s proportional-hazards model to estimate the risk of PUB in hypoalbuminemia patients. Results: We enrolled 3,197 mild hypoalbuminemia patients, 490 severe hypoalbuminemia patients, and 14,748 non-hypoalbuminemia patients from 2000 to 2010. After adjusting for possible confounders, results indicated that the mild hypoalbuminemia group (HR=1.75, p<0.001) and severe hypoalbuminemia (HR=2.80, p< 0.001) had a higher hospitalization rate for PUB, compared with the non-hypoalbuminemia group. Furthermore, non-steroidal antiinflammatory drugs use were critical risk factors for PUB in mild and severe hypoalbuminemia patients. Conclusions: Patients diagnosed with hypoalbuminemia have a significantly elevated risk of developing PUB. Even though albumin normalizes after discharge, more attention should be paid to reduce the PUB risk in patients diagnosed with hypoalbuminemia.