The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorises patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. Further haemorrhage has been consistently described as the most important risk factor for mortality. It is generally accepted that the risk of rebleeding and death is related to many factors, which are not entirely independent of each other.While previous studies have served to indicate which variables are important in determining the risk of rebleeding and death, few attempts have been made to devise a simple and therefore clinically useful risk scoring system that makes use of readily available clinical information to categorise patients by risk. We have used a large uniform database to analyse the risk factors for mortality and we have used the analysis to construct a simple numerical risk scoring system. The primary purpose of this score is to allow case mix assessment for comparative audit. An understanding of the risk associated with any particular patient is an important initial step in the management process. MethodsThe data presented were collected as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. Four health regions in England (North

Objective-To test the hypothesis that minor chronic insults such as smoking, chronic bronchitis, and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range and that variations in the C reactive protein concentration in turn may be associated with levels of cardiovascular risk factors and chronic coronary heart disease.Design-Population based cross sectional study. Setting-General practices in Merton, Sutton, andWandsworth.Subjects-A random sample of 388 men aged 50-69 years from general practice registers. 612 men were invited to attend and 413 attended, of whom 25 non-white men were excluded. The first 303 of the remaining 388 men had full risk factor profiles determined.Interventions-Measurements ofserum C reactive protein concentrations by in house enzyme linked inmunosorbent assay (ELISA); other determinations by standard methods. Coronary heart disease was sought by the Rose angina questionnaire and Minnesota coded electrocardiograms.Main outcome measures-Serum C reactive protein concentrations, cardiovascular risk factor levels, and the presence of coronary heart disease.Results-Increasing age, smoking, symptoms of chronic bronchitis, Helicobacter pylori and Chlamrydia pneumoniae infections, and body mass index were all associated with raised concentrations of C reactive protein. C Reactive protein concentration was associated with raised serum fibrinogen, sialic acid, total cholesterol, triglyceride, glucose, and apolipoprotein B values. C Reactive protein concentration was negatively associated with high density lipoprotein cholesterol concentration. There was a weaker positive relation with low density lipoprotein cholesterol concentration and no relation with apolipoprotein A I value. C Reactive protein concentration was also strongly associated with coronary heart disease.

The incidence of acute upper gastrointestinal haemorrhage is twice that previously reported in England and similar to that reported in Scotland. The incidence increases appreciably with age. Although the proportion of elderly patients continues to rise and mortality increases steeply with age, age standardised mortality is lower than in earlier studies. Deaths occurred almost exclusively in very old patients or those with severe comorbidity.

Background-There is evidence suggesting that early life experience may influence adult risk of coronary heart disease (CHD). Chronic bacterial infections have been associated with CHD. Objective-To determine whether Helicobacter pylori, a childhood acquired chronic bacterial infection, is associated with an increased risk of coronary heart disease in later life. We used a case-control comparison to investigate whether H pylori infection was associated with adult CHD. We also studied possible associations of Hpylori infection with cardiovascular risk factors in the control population. Patients and methods PATlENTSWe studied men aged 45-65. The controls came from a single general practice screening clinic and the cases from a series of consecutive patients referred to the cardiology clinic of a local teaching hospital with angiographically confirmed CHD (stenosis >70% in one coronary artery). Potential controls were excluded if they had a firm diagnosis of CHD. METHODSAll subjects completed a questionnaire and 10 ml of serum was drawn and stored at -20°C. Blood pressure was measured in the general practice when the patient was seated. One observer used the same mercury sphygmomanometer throughout the study.We measured H pylori specific IgG antibody titres by an in-house enzyme linked immunoadsorbent assay (ELISA) in duplicate, using a partially purified antigen as described previously. Results were analysed by multiple logistic regression using GLIM7 and multiple regression using the GLM proceedure in SAS. In the logistic regression models, age was grouped into four categories (45-49, 50-54, 55-59, 60-65) and current social class was grouped into six categories according to the Registrar-General's 1980 classification.

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