Predictive factors of in-hospital mortality in patients with acute severe upper gastrointestinal bleeding
Keywords:
bleeding, upper gastrointestinal tract, mortalityAbstract
Background: Older age, comorbidities and endoscopic stigmata of active bleeding are predictive factors of mortality in patients with acute upper gastrontestinal hemorrhage. Our aim was to assess independent predictors of in-hospital mortality of our patients with acute severe upper gastrointestinal bleeding.
Methods: We reviewed retrospectively charts of 54 patients admitted to ICU due to acute upper gastrointestinal bleeding as demonstrated endoscopically and /or with hypotension and/or tachicardia. Predictors of mortality were tested by univariate and multivariate statistical methods.
Results: Most frequent causes of bleeding were varices, followed by erosions and peptic ulcers. Mortality of our patients was 31.5 %. Between non-survivors and survivors statistically significant differences were observed in hemorhagic shock (82.4 % vs. 27 %, p < 0.001), heart failure (76.5 % vs. 18.9 %, p < 0.001), infection (47 % vs. 10.8 %, p = 0.005), admission diastolic blood pressure (55.4 ± 22 mm Hg vs. 69.7 ± 17.7 mmHg, p = 0.016), admission hemoglobin (74.2 ± 25.7 g/L vs. 94.2 ± 22.2 g/L, p = 0.005), erythrocytes (2.4 ± 0.7 10.1012/ L vs. 3 ± 0.7 10.1012/L, p = 0.005), lowest hemoglobin (65.8 ± 24.3 g/L vs. 80 ± 18.3 g/L, p = 0.02) and erythrocytes (2 ± 0.7 10.1012/L vs. 2.5 ± 0.6 10.1012/L, p = 0.007) during treatment. According to logistic regression the heart failure, followed by the lowest hemoglobin and erythrocytes were most significant independent predictors of mortality of our patients.
Conclusions: Variceal bleeding was most frequent cause of upper gastrointestinal hemorrhage. Heart failure was most significant independent predictor of in-hospital mortality, being 31.5 %.
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References
Esrailian E, Gralnek IM. Nonvariceal upper gastrointestinal bleeding: Epidemiology and diagnosis. Gastroenterol Clin N Am 2005; 34: 589– 605.
Palmer K. Management of haematemesis and melaena. Postgrad Med J 2004; 80: 399–404.
Lecleire S, Di Fiore F, Merle V, Herve S, Duhamel C, Rudelli A, et al. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients. Epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol 2005; 39: 321–7.
Collins D, Worthley LIG. Acute gastrointestinal bleeding: Part I. Crit Care Resus 2001; 3: 105–16.
Collins D, Worthley LIG. Acute gastrointestinal bleeding: Part II. Crit Care Resus 2001; 3: 117– 24.
Manning-Dimmit LL, Dimmit SG, Wilson GR. Diagnosis of gastrointestinal bleeding in adults. Am Fam Physician 2005; 71: 1339–46.
Marino PL. The ICU book. Philadelphia: Lippincott Williams Wilkins; 1998.
Skok P, Skok M. Krvaveča peptična razjeda: primerjava učinkovitosti dveh metod endoskopske hemostaze – prospektivna raziskava. Zdrav Vestn 2004; 73: 181–6.
Bull.S.S.C.C./S.G.K.C. Enzymes supplement 1982; 23: 5.
Khuroo MS, Khuroo M, Farahat KLC, Kagevt IE. Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: A meta-analysis. J Gastroenterol Hepatol 2005; 20: 11–25.
Comar KM, Sanyal AJ. Portal hypertensive bleeding. Gastroenterol Clin N Am 2003; 32: 1079–1105.
Groeneveld ABJ, Tran DD, van der Meulen J, et al. Acute renal failure in the medical intensive care unit: Predisposing, complicating factors and outcome. Nephron 1991; 59: 602–10.
Taha AS, Angerson WJ, Knill-Jones RP, Blatchfords O. Upper gastrointestinal haemorrhage associated with low-dose aspirin and anti-thrombotic drugs – a 6-year analysis and comparison with non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2005; 22: 285–9.
Rockall TA, Logan RFA, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–21.
Skok P, Ćeranić D, Sinkovič A, Pocajt M. Peptic ulcer hemorrhage: Argon plasma coagulation versus injection sclerotherapy: a prospective, randomized, controlled study. Verdauungskrankheiten 2001; 19: 107–13.
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