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We read with interest the paper by Wong et al (Gut 2002;50:322–5) on prediction of therapeutic failure in patients with bleeding peptic ulcer but are surprised they did not include smoking in their logistic regression analysis. The background prevalence of smoking is sufficiently high in western communities to be a useful marker if found significant. The association between smoking and ulcer healing1 and smoking and cardiovascular and respiratory disease raises the issue of whether smoking may be a risk factor both for ulcer rebleeding and mortality. It is recognised that cardiovascular and respiratory comorbidity is a substantial contributor to peptic ulcer disease related mortality.2 Addition of smoking may improve the predictive performance of their receiver operating curve and the value of their “model” in clinical practice.
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