Non-Variceal Upper GI Bleeding in Patients Already Hospitalized for Another Condition

Müller, Tanja M.; Barkun, Alan N.; Martel, Myriam

doi:10.1038/ajg.2008.62

Cited by 58 publications

(50 citation statements)

References 49 publications

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“…The association between lower serum albumin values and higher UGIB risk is also supported by a previous study in patients with CKD receiving dialysis (19). A history of UGIB is an important risk factor but has not been taken into consideration in previous studies (1)(2)(3)6,(20)(21)(22). Our study showed that patients with CKD and a history of UGIB had a 2-fold higher risk of UGIB.…”

Section: Discussionsupporting

confidence: 77%

Upper Gastrointestinal Bleeding in Patients with CKD

Liang

Wang

Kuo

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Results In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m 2 higher eGFR. A history of upper gastrointestinal bleeding (P,0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk. ConclusionsIn patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.

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Section: Discussionsupporting

confidence: 77%

Upper Gastrointestinal Bleeding in Patients with CKD

Liang

Wang

Kuo

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The mortality of GI complications in the postcardiac surgery patient has long been noted to be high [9]. Our findings of a 19.1% mortality confirm that this is still true today and in fact remains very elevated, even when compared to an unselected group of patients with in-hospital onset of nonvariceal UGI bleeding in the same country for whom the observed mortality rate was 11% [10].…”

Section: Discussionsupporting

confidence: 75%

“…However, in most reports, commonly reported lesions at endoscopy have included, as in our series, gastroduodenal ulcers or erosions and esophagitis [12,[20][21][22]. These findings are similar to those noted for in-hospital and outpatient patients presenting with an episode of NVUGIB [5,10]. Subsequent management therefore utilizes similar therapeutic approaches including the performance of early endoscopy, therapeutic hemostasis, and pharmacotherapy in appropriate patients [4].…”

Section: Discussionsupporting

confidence: 72%

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Amorim

Barkun

Larocque

et al. 2012

Ulcers

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Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

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“…Recent prospective studies have identified different predictors of mortality; it is worth noting that the use of proton pump inhibitors (PPIs) significantly reduces mortality in patients both with and without high risk stigmata of rebleeding. Moreover, the use of endoscopic treatment has been demonstrated to reduce mortality in greater proportion than drug treatment (3)(4)(5)(6). However, it has been shown that the risk factors, complications and mortality rates described in controlled trials are lower than those reported in patients who received their attention on "day-today conditions" in a tertiary care community hospital (7), which illustrates more accurately the actual conditions of medical care.…”

Section: Introductionmentioning

confidence: 76%

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

González-González

Vázquez-Elizondo

García-Compeán

et al. 2011

Rev. esp. enferm. dig.

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Objective: to determine the independent predictors of in-hospital death of Hispanic patients with nonvariceal upper gastrointestinal bleeding (NVUGB).Experimental design: prospective and observational trial. Patients: in a period between 2000 and 2009, all patients with NVUGB admitted to our hospital were studied. Demographical and clinical characteristics, endoscopic findings and laboratory tests were evaluated. χ² and Mann-Whitney U analyses were performed for comparisons, and binary logistic regression was employed to identify independent predictors of in-hospital mortality.Results: 1,067 patients were included, 65% male with a mean age of 58.8 years. Mean number of comorbidities per patient was 1.6 ± 0.76. The most frequent cause of bleeding were gastric and duodenal ulcers (55.4%); 278 patients (25.8%) received endoscopic treatment of which 69.1% had combined therapy. Rebleeding occurred in 36 patients (3.4%) of which 50% died. Inhospital mortality was 10.2%, of which only 3.1% was associated to bleeding. When comparing causes of death among patients with and without comorbidities, only hypovolemic shock was found significative (48.3 vs. 25%; p = 0.020). Binary logistic regression found that the number of comorbidities, Rockall scale serum albumin < 2.6 g/dL on admission; rebleeding and length of hospital stay were independent risk factors of in-hospital mortality.Conclusion: the number of comorbidities, the Rockall scale score, an albumin level < 2.6 g/dL, the presence of rebleeding and hospital stay were predictors of in-hospital mortality in patients with UNVGB. INTRODUCTIONNon-variceal upper gastrointestinal bleeding (NVUGB) is a critical condition in which a mortality of 5 to 10% has been reported in different series of patients. This variability may be explained in part by the different clinical and demographic characteristics of the studied population (1,2). Recent prospective studies have identified different predictors of mortality; it is worth noting that the use of proton pump inhibitors (PPIs) significantly reduces mortality in patients both with and without high risk stigmata of rebleeding. Moreover, the use of endoscopic treatment has been demonstrated to reduce mortality in greater proportion than drug treatment (3-6). However, it has been shown that the risk factors, complications and mortality rates described in controlled trials are lower than those reported in patients who received their attention on "day-today conditions" in a tertiary care community hospital (7), which illustrates more accurately the actual conditions of medical care.The main objective of our study is to describe the clinical characteristics, endoscopic findings, and treatment used, as well as risk factors of complications and in-hospital mortality in Hispanic patients with NVUGB on "day-to-day conditions". Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleedingJosé Alberto González-González, Genaro Vázquez-Elizondo, Diego García-Compeán, Juan Obed Gaytán-Torres, Ángel Ricardo ...

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Non-Variceal Upper GI Bleeding in Patients Already Hospitalized for Another Condition

Abstract: IPs are sicker than OPs. Endoscopic hemostasis and PPI therapy favorably affect rebleeding in IPs, whereas patient characteristics principally determine the threefold greater IPs mortality.

Cited by 58 publications

References 49 publications

Upper Gastrointestinal Bleeding in Patients with CKD

Upper Gastrointestinal Bleeding in Patients with CKD

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

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