Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2019; 11(12): 561-572
Published online Dec 16, 2019. doi: 10.4253/wjge.v11.i12.561
In-hospital acute upper gastrointestinal bleeding: What is the scope of the problem?
Fady G Haddad, Talal El Imad, Najib Nassani, Raymond Kwok, Hassan Al Moussawi, Abhishek Polavarapu, Moiz Ahmed, Youssef El Douaihy, Liliane Deeb
Fady G Haddad, Talal El Imad, Hassan Al Moussawi, Abhishek Polavarapu, Youssef El Douaihy, Liliane Deeb, Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
Najib Nassani, Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, IL 60607, United States
Raymond Kwok, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
Moiz Ahmed, Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, Elmhurst, NY 11373, United States
Author contributions: Deeb L designed the research; Deeb L and Haddad FG supervised the report; Haddad FG, El Imad T and Nassani N analyzed the data and wrote the paper; El Imad T, Nassani N, Kwok R, Al Moussawi H, Polavarapu A and Ahmed M performed the research; El Douaihy Y analyzed data.
Institutional review board statement: This study was reviewed and approved by the Staten Island University Hospital Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fady G Haddad, MD, Doctor, Department of Gastroenterology and Hepatology, Staten Island University Hospital, 475 Seaview avenue, Staten Island, NY 10305, United States. fhaddad@northwell.edu
Telephone: +1-347-7617767 Fax: +1-718-2268979
Received: June 22, 2019
Peer-review started: June 23, 2019
First decision: August 19, 2019
Revised: August 29, 2019
Accepted: October 2, 2019
Article in press: October 2, 2019
Published online: December 16, 2019
Processing time: 154 Days and 5.4 Hours
Abstract
BACKGROUND

Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%. Despite recent newer innovations and advancements in endoscopic techniques and available medications, the mortality rate associated with AUGIB remained persistently elevated.

AIM

To explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.

METHODS

This is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically. Patients were divided in two groups: Group 1 comprised patients who developed AUGIB during their hospital stay; group 2 consisted of patients who initially presented with AUGIB as their main complaint. Patient characteristics, time to endoscopy, endoscopy findings and interventions, and clinical outcomes were collected and compared between groups.

RESULTS

A total of 336 patients were included. Group 1 consisted of 139 patients and group 2 of 196 patients. Mortality was significantly higher in the 1st group compared to the 2nd (20% vs 3.1%, P ≤ 0.05). Increased length of stay (LOS) was noted in the 1st group (13 vs 6, P ≤ 0.05). LOS post-endoscopy, vasopressor use, number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1. Inpatients were more likely to be on corticosteroids, antiplatelets and anticoagulants. Conversely, the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.

CONCLUSION

In-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy. Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.

Keywords: Upper gastrointestinal bleeding; Melena; Hematemesis; Variceal bleeding; Non-variceal bleeding; Mortality; Length of stay

Core tip: This is a retrospective study to evaluate acute upper gastrointestinal bleeding (AUGIB). We compared characteristics and outcomes between patients who develop AUGIB while in-hospital and patients who initially present with AUGIB. In-hospital patients had elevated mortality and morbidity, with higher vasopressor use and extended length of stay. Antithrombotic use constituted a robust risk factor for in-hospital AUGIB. Interestingly, the shorter time to endoscopy in inpatients did not offset their worse outcomes. To determine whether this observation is related to increased comorbidities and antithrombotic use in in-hospital bleeders, larger scale studies are warranted to shed more light on this important matter.