title: Poor outcomes in hospitalized patients with gastrointestinal bleeding: impact of baseline risk, bleeding severity, and process of care.
abstract: OBJECTIVE
  Previous studies have found higher mortality rates among inpatients (IPs) compared with new admissions (outpatients, OPs) with acute upper gastrointestinal bleeding (AUGIB), but no studies have investigated the cause for this. The objective of this study was to determine whether the difference in outcomes between IPs and OPs with AUGIB can be explained by differences in baseline characteristics, bleeding severity, or processes of care.
  
  
  METHODS
  Data were collected from 6,657 presentations with all-cause AUGIB from 212 UK hospitals as part of a nationwide audit.
  
  
  RESULTS
  IPs were older (77 vs. 65 years, P<0.001), had greater comorbidity, and presented with more severe bleeding. There was no difference in median time to endoscopy (24 vs. 24 h, P=0.67) or receipt of endotherapy (19% vs. 17%, P=0.29). IPs had an odds of mortality 4.8 times that of OPs (26% vs. 7%; odds ratio (OR) 4.8, 95% confidence interval (CI) 3.9-5.8); after adjusting for baseline characteristics, this fell by 24% to 3.3 (95% CI 3.2-4.9) and after adjusting for bleeding severity alone to 4.0 (95% CI 3.2-4.9); adjusting for care processes had minimal effect. IPs had more than a twofold increased odds of rebleeding (20% vs. 12%; OR 2.1, 95% CI 1.7-2.5); adjusting for both baseline characteristics and severity of bleeding reduced this by 50% (OR 1.4, 95% CI 1.3-2.4), but process of care had no additional impact.
  
  
  CONCLUSIONS
  IPs present with both higher baseline risks and more severe bleeding. These differences in baseline characteristics explain some but not all of the greater mortality of IPs with AUGIB.
authors.affiliation: 1] Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK [2] NHS Blood and Transplant Unit, John Radcliffe Hospital, Oxford,UK.
authors.forename: Vipul
authors.initials: V
authors.lastname: Jairath
authors.affiliation: MRC Clinical Trials Unit, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Thompson
authors.affiliation: MRC Clinical Trials Unit, London, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Kahan
authors.affiliation: Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Daniel
authors.affiliation: Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Hearnshaw
authors.affiliation: Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: S P L
authors.initials: SP
authors.lastname: Travis
authors.affiliation: NHS Blood and Transplant Unit, John Radcliffe Hospital, Oxford,UK.
authors.forename: M F
authors.initials: MF
authors.lastname: Murphy
authors.affiliation: Western General Hospital, Edinburgh, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Palmer
authors.affiliation: Division of Epidemiology and Public Health & Nottingham Digestive Disease Centre University of Nottingham, Nottingham, UK.
authors.forename: R F A
authors.initials: RF
authors.lastname: Logan
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D061665:Time-to-Treatment; D006113:United Kingdom
chemical_list: D054328:Proton Pump Inhibitors