title: Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis.
abstract: OBJECTIVE
  To investigate the prevalence and risk factors of upper gastrointestinal bleeding (UGIB) in patients with severe acute pancreatitis (SAP).
  
  
  METHODS
  Altogether 101 patients were admitted to the Department of Gastroenterology, Changhai Hospital, Second Medical Military Hospital from July 2006 to June 2010 due to SAP. Their prevalence and risk factors of UGIB were retrospectively analyzed.
  
  
  RESULTS
  In total, 18 (17.8%) patients developed UGIB and 13 received endoscopic examination, which yielded six cases of acute gastric mucosal lesions (AGML), five of peptic ulcers (PU) and two of pancreatic necrotic tissue invading the duodenal bulb and presenting as multilesion, honeycomb-like ulcer. The mortality rate of UGIB patients was much higher than that of non-UGIB patients (44.4% vs 10.8%, P = 0.0021). Univariate analysis revealed that the risk factors for UGIB included the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, computed tomography severity index (CTSI), Ranson score, arterial blood pH and PaO2 , serum blood urea nitrogen and creatinine concentrations, platelet count, shock, sepsis and organ failure, mechanical ventilation, heparinized continuous renal replacement therapy and total parenteral nutrition. Multivariate logistic regression revealed that APACHE II score and CTSI were significant risk factors while PaO2 was the protective factor for UGIB in SAP.
  
  
  CONCLUSIONS
  UGIB is a common complication with poor prognosis due mainly to PU and AGML. Patients having SAP with high APACHE II scores and CTSI or low PaO2 should be considered to be at high risk for UGIB.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xian Bao
authors.initials: XB
authors.lastname: Zhan
authors.forename: Xiao Rong
authors.initials: XR
authors.lastname: Guo
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Zhao Shen
authors.initials: ZS
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000097:blood / Q000150:complications*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D010437:Peptic Ulcer / Q000209:etiology; D010976:Platelet Count; D015995:Prevalence; D012076:Renal Agents / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology; D014057:Tomography, X-Ray Computed; D041742:Upper Gastrointestinal Tract / Q000473:pathology; D012122:Ventilators, Mechanical / Q000009:adverse effects
chemical_list: D012076:Renal Agents; D003404:Creatinine
keywords: acute gastric mucosal lesion; acute pancreatitis; peptic ulcer; risk factor; upper gastrointestinal bleeding