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.
Marmo
Riccardo
R
Division of Gastroenterology, Hospital "L.Curto," Polla, Via Sottobraida 32, 84037 Sant'Arsenio, Italy.
Koch
Maurizio
M
Cipolletta
Livio
L
Capurso
Lucio
L
Pera
Angelo
A
Bianco
Maria A
MA
Rocca
Rodolfo
R
Dezi
Angelo
A
Fasoli
Renato
R
Brunati
Sergio
S
Lorenzini
Ivano
I
Germani
Ugo
U
Di Matteo
Giovanni
G
Giorgio
Paolo
P
Imperiali
Giorgio
G
Minoli
Giorgio
G
Barberani
Fausto
F
Boschetto
Sandro
S
Martorano
Marco
M
Gatto
Giovanni
G
Amuso
Mariano
M
Pastorelli
Alfredo
A
Torre
Elena S
ES
Triossi
Omero
O
Buzzi
Andrea
A
Cestari
Renzo
R
Della Casa
Domenico
D
Proietti
Massimo
M
Tanzilli
Anna
A
Aragona
Giovanni
G
Giangregorio
Francesco
F
Allegretta
Luciano
L
Tronci
Salvatore
S
Michetti
Paolo
P
Romagnoli
Paola
P
Nucci
Andrea
A
Rogai
Francesca
F
Piubello
Walter
W
Tebaldi
Maria
M
Bonfante
Fabrizio
F
Casadei
Alessandro
A
Cortini
Claudio
C
Chiozzini
Giorgio
G
Girardi
Lisa
L
Leoci
Claudio
C
Bagnalasta
Giampiero
G
Segato
Sergio
S
Chianese
Giuseppe
G
Salvagnini
Mario
M
Rotondano
Gianluca
G
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