Prognostic Factors for Continued or Rebleeding and Death From Gastrointestinal Haemorrhage in the Elderly

Abstract

We analysed 103 episodes of upper gastrointestinal bleeding in 88 elderly patients (age 76 +/- 7.7 years) to determine which of a group of 52 clinical and laboratory variables, measured on admission, best predicted continued or rebleeding, and death in these patients. Variables which related directly to the size of the bleed (blood urea, haemoglobin, pulse rate, systolic blood pressure) were all strongly predictive of both outcomes (P less than 0.001). Of the variables unrelated to the size of the bleed, prolonged prothrombin time and elevated serum creatinine were most strongly predictive of a poor outcome, suggesting that haemostatic dysfunction may be a major contributor to death from upper gastrointestinal haemorrhage in elderly patients. Other variables with strong predictive potential were age (P less than 0.001), the presence of multiple disease states (P less than 0.01), therapy with multiple drugs (P less than 0.01) and acute stroke or obtundation on admission (P less than 0.01). In general terms the size of the bleed was as significant as the premorbid condition of the patient in predicting the outcome. This, together with the fact that half the patients died of hypovolaemia, suggests that death from upper gastrointestinal bleeding in the elderly is not inevitable and that further reduction in mortality from this cause is attainable.

Acute Upper Gastrointestinal Hemorrhage in Older People: A Prospective Study in Two Neighboring Districts

“…The single postoperative death was not attributable directly to surgery or peptic ulcer disease. Risk factors for operative mortality are well publicized 2–9 . In general, there are four broad categories of patients with peptic ulcer disease who need early surgical intervention: those with previous history of UGIH, those actively bleeding from a gastric or duodenal ulcer, especially with a visible blood vessel in an ulcer crater, those requiring 6 or more units of blood in the first 24 hours, and those with onset of hemorrhagic shock despite adequate resuscitation.…”

The Clinical and Endoscopic Profiles of Patients With Upper Gastrointestinal Bleeding (UGIB) and the Role of the Rockall Scoring System in Predicting Adverse Outcomes

“…Coronary artery disease (CAD), chronic liver disease, large varices, those undergoing endotherapy, renal failure, low Hb, high pulse rate, low systolic blood pressure, increased INR, those in need of blood transfusion, and Rockall score of >3 were significant predictive factors in rebleeders as compared to non-rebleeders. Booker et al [ 16 ] also reported that renal failure, low Hb, high pulse rate, low systolic blood pressure, prolonged PT, and elevated serum creatinine were strong predictors of rebleed.…”