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Risk factors for mortality in severe upper gastrointestinal bleeding

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Factors related to mortality after upper gastrointestinal (GI) bleeding may differ in importance in high- and low-risk populations. This retrospective study was undertaken to define risk factors of mortality in patients needing endoscopy for upper gastrointestinal bleeding at a tertiary care centre.

Patients/methods

Three hundred and sixty-two patients with upper gastrointestinal bleeding were identified from endoscopy charts. Patients’ characteristics, bleeding parameters, clinical presentation, pre-existing medication and laboratory data were retrieved from hospital charts and patients who survived and those who died in hospital were compared.

Results/findings

The mean Rockall score was 6.6±1.3 with 92.5% of patients belonging to a Rockall high-risk group. In hospital, mortality was 26.5%, with 6.4% of patients dying as a direct consequence of bleeding. Variceal bleeding was associated with a high risk of recurrent bleeding and death. Renal disease, liver disease, coagulopathy and immunosuppression were more frequently found in non-survivors than in survivors. Accordingly, serological tests of renal or liver function and coagulation were more disturbed in non-survivors. On average, heart rate was higher, and blood pressure and haemoglobin levels lower in non-survivors. Heparin, glucocorticoids, and anti-ulcer drugs were more frequently used in patients dying in hospital. By logistic regression analysis, in-patient status at the time of bleeding, renal disease and coagulopathy, as well as glucocorticoid use, were risk factors for hospital mortality.

Interpretation/conclusion

In tertiary care, a high mortality rate is observed in upper GI bleeding. Teams involved in treating such patients should be aware of the setting in which treatment is performed and its related risk factors.

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Author notes

  1. Helmut Messmann

    Present address: Department of Internal Medicine III, Augsburg Hospital, Augsburg, Germany

Authors and Affiliations

  1. Department of Internal Medicine I, University of Regensburg, 93042, Regensburg, Germany

    Frank Klebl, Nicole Bregenzer, Lars Schöfer, Wolfgang Tamme, Julia Langgartner, Jürgen Schölmerich & Helmut Messmann

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  1. Frank Klebl
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  2. Nicole Bregenzer
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  3. Lars Schöfer
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  4. Wolfgang Tamme
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Correspondence to Frank Klebl.

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Klebl, F., Bregenzer, N., Schöfer, L. et al. Risk factors for mortality in severe upper gastrointestinal bleeding. Int J Colorectal Dis 20, 49–56 (2005). https://doi.org/10.1007/s00384-004-0624-2

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  • DOI: https://doi.org/10.1007/s00384-004-0624-2

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