title: Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors.
abstract: OBJECTIVE
  To analyze the clinical characteristics, outcomes and prognostic factors in elderly patients (aged 75 years and elder) with acute nonvariceal upper gastrointestinal bleeding (UGIB).
  
  
  METHODS
  Consecutive patients admitted with acute nonvariceal UGIB who underwent upper gastrointestinal endoscopy were prospectively recruited and subdivided into two age-based groups, elderly (aged ≥75 years) and younger patients (<75 years). The patients' characteristics and outcomes were recorded.
  
  
  RESULTS
  Altogether 1136 patients were included in the study, 276 (24.3%) aged ≥75 years. Peptic ulcers, gastroduodenal erosions and esophagitis represented the three most common endoscopic lesions found in 87.7% of the elderly patients compared with 80.8% in younger patients ( P  = 0.008). Overall, the rebleeding rate (4.0% vs 3.3%, P = 0.568), need for blood transfusion (66.3% vs 61.0%, P = 0.122), surgery rate (1.2% vs 1.4%, P = 0.947) and in-hospital mortality (13.0% vs 10.0%, P = 0.157) were not different between the two groups. In elderly patients, serum albumin was the only predictive variable independently associated with mortality in the overall analysis (OR 5.867, 95% CI 2.206-15.604, P < 0.001) and in the subgroup patients with peptic ulcers (OR 5.230, 95% CI 2.099-13.029, P = 0.001). Elderly patients with serum albumin >23.5 g/L at admission presented a low mortality (negative predictive value 97.3%).
  
  
  CONCLUSIONS
  Clinical evolution and mortality do not differ between the elderly and younger patients with acute nonvariceal UGIB. Serum albumin level at admission is a prognostic marker for mortality in elder patients.
authors.affiliation: Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: José A
authors.initials: JA
authors.lastname: González-González
authors.affiliation: Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Monreal-Robles
authors.affiliation: Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: Diego
authors.initials: D
authors.lastname: García-Compean
authors.affiliation: Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Paz-Delgadillo
authors.affiliation: Department of Internal Medicine, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: Martín
authors.initials: M
authors.lastname: Wah-Suárez
authors.affiliation: Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
authors.forename: Héctor J
authors.initials: HJ
authors.lastname: Maldonado-Garza
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012151:Resuscitation / Q000379:methods; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: endoscopic therapy; gastrointestinal hemorrhage; mortality; older patient; peptic ulcer