Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study.
OBJECTIVE
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.
Division of Gastroenterology, Hospital "L.Curto," Polla, Via Sottobraida 32, 84037 Sant'Arsenio, Italy.
Riccardo
R
Marmo
Maurizio
M
Koch
Livio
L
Cipolletta
Lucio
L
Capurso
Angelo
A
Pera
Maria A
MA
Bianco
Rodolfo
R
Rocca
Angelo
A
Dezi
Renato
R
Fasoli
Sergio
S
Brunati
Ivano
I
Lorenzini
Ugo
U
Germani
Giovanni
G
Di Matteo
Paolo
P
Giorgio
Giorgio
G
Imperiali
Giorgio
G
Minoli
Fausto
F
Barberani
Sandro
S
Boschetto
Marco
M
Martorano
Giovanni
G
Gatto
Mariano
M
Amuso
Alfredo
A
Pastorelli
Elena S
ES
Torre
Omero
O
Triossi
Andrea
A
Buzzi
Renzo
R
Cestari
Domenico
D
Della Casa
Massimo
M
Proietti
Anna
A
Tanzilli
Giovanni
G
Aragona
Francesco
F
Giangregorio
Luciano
L
Allegretta
Salvatore
S
Tronci
Paolo
P
Michetti
Paola
P
Romagnoli
Andrea
A
Nucci
Francesca
F
Rogai
Walter
W
Piubello
Maria
M
Tebaldi
Fabrizio
F
Bonfante
Alessandro
A
Casadei
Claudio
C
Cortini
Giorgio
G
Chiozzini
Lisa
L
Girardi
Claudio
C
Leoci
Giampiero
G
Bagnalasta
Sergio
S
Segato
Giuseppe
G
Chianese
Mario
M
Salvagnini
Gianluca
G
Rotondano
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D006304:Health Status; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis
D006454:Hemoglobins