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

作     者：Daniela Cornelia Lazar Sorin Ursoniu Adrian Goldis 

作者机构：Department of Internal Medicine IUniversity Medical ClinicUniversity of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania Department of Public Health and Health ManagementUniversity of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania Department of Gastroenterology and HepatologyUniversity of Medicine and Pharmacy "Victor Babes"Timisoara 300041Timis CountyRomania 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2019年第7卷第18期

页      面：2687-2703页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Nonvariceal upper digestive bleeding Risk factors Rebleeding Death Outcome 

摘      要：BACKGROUND Nonvariceal 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. AIM To 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. METHODS We 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 *** We 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 out