Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: A multicenter study

Riccardo Marmo, Maurizio Koch, Livio Cipolletta, Lucio Capurso, Angelo Pera, Maria A. Bianco, Rodolfo Rocca, Angelo Dezi, Renato Fasoli, Sergio Brunati, Ivano Lorenzini, Ugo Germani, Giovanni Di Matteo, Paolo Giorgio, Giorgio Imperiali, Giorgio Minoli, Fausto Barberani, Sandro Boschetto, Marco Martorano, Giovanni GattoMariano Amuso, Alfredo Pastorelli, Elena S. Torre, Omero Triossi, Andrea Buzzi, Renzo Cestari, Domenico Della Casa, Massimo Proietti, Anna Tanzilli, Giovanni Aragona, Francesco Giangregorio, Luciano Allegretta, Salvatore Tronci, Paolo Michetti, Paola Romagnoli, Andrea Nucci, Francesca Rogai, Walter Piubello, Maria Tebaldi, Fabrizio Bonfante, Alessandro Casadei, Claudio Cortini, Giorgio Chiozzini, Lisa Girardi, Claudio Leoci, Giampiero Bagnalasta, Sergio Segato, Giuseppe Chianese, Mario Salvagnini, Gianluca Rotondano

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: From an Italian Registry of patients with upper gastrointestinal hemorrhage (UGIH), we assessed the clinical outcomes and explored the roles of clinical, endoscopic, and therapeutic factors on 30-day mortality in a real life setting.Methods: Prospective analysis of consecutive patients endoscoped for UGIH at 23 community and tertiary care institutions from 2003 to 2004. Covariates and outcomes were defined a priori and 30-day follow-up obtained. Logistic regression analysis identified predictors of mortality.Results: One thousand and twenty patients were included. A total of 46 patients died for an overall 4.5% mortality rate. In all, 85% of deaths were associated with one or more major comorbidity. Sixteen of 46 patients (35%) died within the first 24 h of the onset of bleeding. Of these, eight had been categorized as ASA class 1 or 2 and none of them was operated upon, despite a failure of endoscopic intention to treatment in four. Regression analysis showed advanced age, presence of severe comorbidity, low hemoglobin levels at presentation, and worsening health status as the only independent predictors of 30-day mortality (P <0.001). The acute use of a PPI exerted a protective effect (OR 0.23, 95% CI 0.09-0.73). Recurrent bleeding was low (3.2%). Rebleeders accounted for only 11% of the total patients deceased (OR 3.27, 95% CI 1.5-11.2).Conclusions: These results indicate that 30-day mortality for nonvariceal bleeding is low. Deaths occurred predominantly in elderly patients with severe comorbidities or those with failure of endoscopic intention to treatment.

Original languageEnglish
Pages (from-to)1639-1647
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume103
Issue number7
DOIs
Publication statusPublished - Jul 2008

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

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