Predictors of rebleeding and mortality in patients with high-risk bleeding peptic ulcers.
OBJECTIVE
Patients with bleeding ulcers can have recurrent bleeding and mortality after endoscopic therapy. Risk stratification is important in the management of the initial patient triage. The aim of this study is to identify the clinical and laboratory risk factors for recurrent bleeding and mortality.


METHODS
A prospective study was conducted in 390 consecutive patients with bleeding peptic ulcers and high-risk endoscopic stigmata, e.g., active bleeding, a non-bleeding visible vessel, adherent blood clot, and hemorrhagic dot. We tested 13 available variables for association with recurrent bleeding and 15 were tested for association with mortality. A logistic regression model was used to identify individual correlates associated with these adverse outcomes.


RESULTS
Bleeding recurred in 46 patients (11.8%) within 3 days and 21 patients (5.4%) had in-hospital mortality. In the full-factor analysis model, the incidence of recurrent bleeding was significantly higher in five of the 13 investigated variables and mortality was significantly higher in two of the 15 variables. In the final analysis model, significant risk factors for recurrent bleeding within 3 days, with adjusted odds ratios (OR), were in-hospital bleeding (OR 3.3), initial hemoglobin level<10 g/dl (OR 3.3) and ulcer>or=2 cm (OR 2.0). In-hospital bleeding was the only independent risk factor for mortality (OR 8.3).


CONCLUSIONS
The study emphasizes the role of ulcer size, anemia and in-hospital bleeding as the determining high-risk predictors for adverse outcomes for bleeding peptic ulcers.
Cheng
Chi-Liang
CL
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin Street, Queishan, Taoyuan County, 333, Taiwan, ROC. clcheng@adm.cgmh.org.tw
Lin
Cheng-Hui
CH
Kuo
Chia-Jung
CJ
Sung
Kai-Feng
KF
Lee
Ching-Song
CS
Liu
Nai-Jen
NJ
Tang
Jui-Hsiang
JH
Cheng
Hao-Tsai
HT
Chu
Yin-Yi
YY
Tsou
Yung-Kuan
YK
D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006454:Hemoglobins