Prognostic factors in upper gastrointestinal bleeding.
In this study we examined factors of possible prognostic value about outcome in a consecutive series of 2217 patients with hematemesis and melena. Death occurred in 189 (8.5%) patients, and 243 (11%) patients experienced rebleeding. Death was significantly associated with rebleeding, age over 60 years, and the finding of blood in the stomach at endoscopy. Rebleeding was significantly associated with melena, identification of a gastric or duodenal ulcer, endoscopic stigmata of hemorrhage such as blood, clot, and active bleeding, and the finding of shock at admission. However, female gender, previous history of ulceration, or indigestion of ulcerogenic drugs, especially nonsteroidal antiinflammatory drugs, were poor predictors of either death or rebleeding. We conclude that the identification of patients at a high risk could contribute to improved management of patients with gastrointestinal bleeding, including early therapeutic intervention.
Katschinski
B
B
Department of Therapeutics and Epidemiology, University Hospital, Nottingham, UK.
Logan
R
R
Davies
J
J
Faulkner
G
G
Pearson
J
J
Langman
M
M
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002927:Cimetidine / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000150:complications; D005260:Female; D006396:Hematemesis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008551:Melena / Q000188:drug therapy / Q000401:mortality*; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D013004:Somatostatin / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications; D014148:Tranexamic Acid / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013004:Somatostatin; D014148:Tranexamic Acid; D002927:Cimetidine