Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding

Abstract

BACKGROUNDNonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high.AIMTo identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management.METHODSWe performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death; we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB.RESULTSWe included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%; surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases; the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death; comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03).CONCLUSIONOur study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for in-hospital mortality.

Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding

“…[ 20 ] In contrast, a high-risk score is associated with a high blood transfusion rate, the need for endoscopic therapy, and prolonged hospitalization. [ 21 , 22 ] In our study, severe anemia ( P = .03) was an independent predictor of mortality.…”

Predictors of Rebleeding in Non-variceal Upper Gastrointestinal Bleeding of Peptic Ulcer Etiology in Kashmiri Population

“…Our patients were younger compared to contemporary studies and majority were in the third to sixth decade of life with a mean age of 40.9±15.9 years. This is in comparison to other studies by Villanueva et al[8], Travis et al[9], Liu et al[10], Daniela et al[11], Laursen et al[12], and Bitar et al[13] where in the mean age of studied subjects was 64.9±15; 64.9±15.3, 55.3±17.8,66,74, 52±16.8 years, respectively. Most of our patient population 361/480 (75%) was from rural areas but gender was equally distributed between the two groups.…”

“…Patients with high-risk stigmata after endoscopic therapy were observed for 72 hours and were continued on high-dose proton pump inhibitor therapy. Fourteen out of 480 patients rebled as per definition; 13 among the high-risk stigmata group and one from the low-risk group (IIC) giving an overall rebleeding rate of only 2.9% compared to 8%, 21%, 7.7%, 10.8%, 13%, and 17%, in other studies [ 8 , 9 , 11 , 12 , 15 , 18 ], respectively. If calculated for high-risk stigmata only, i.e., 13/267; the rebleeding rate was 4.8%, which is still lower than other studies.…”

“…One of the important predictors of rebleeding is the endoscopic stigmata of ulcers given by the Forest class. We had more number of patients in Forest class III (39.8%) followed by Ib (32%) and IIa (15.6%) which is higher as compared to 29%, 36.4%, and 25% [ 10 , 11 , 15 ] for class III; 31% and 18.6% for Ib [ 8 , 15 ] and lower as compared to 66% and 32% [ 8 , 9 ] for class IIa, respectively. In other studies, one of the patients in class III rebled in our study whereas only two out of 188 patients rebled in a study by Guglielmi et al [ 15 ].…”

Peri-Ulcerative Mucosal Inflammation Appearance is an Independent Risk Factor for 30-Day Rebleeding in Patients with Gastric Ulcer Bleeding: A Multicenter Retrospective Study

“…These include large ulcers, the diameter of exposed vessels, anatomical location, treatment methods, and some concomitant diseases. [5][6][7][8][9][10] Previous research has also established a variety of scoring systems in an attempt to assess the prognosis of patients more accurately. 11,12 However, the previous research results still cannot allow clinicians to perfectly predict the prognosis of patients with ulcer bleeding.…”