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
ARTICLE HIGHLIGHTS
Research background

Acute upper gastrointestinal bleeding (AUGIB) is a common medical problem encountered in the Gastroenterology field.

Research motivation

Despite major advances in medical and endoscopic therapy over the last few decades, AUGIB is still associated with high mortality and morbidity.

Research objectives

The aim of this retrospective study was to explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.

Research methods

This is a retrospective observational study of endoscopy-confirmed AUGIB patients who presented to Staten Island University Hospital from October 2012 to October 2016. They 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.

Research 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, patients requiring fresh frozen plasma, and mean number of packed red blood cells units were higher in the 1st group. Group 1 patients were more likely to be on antiplatelets, anticoagulants, and corticosteroids. On the other hand, the mean time from the recognition of bleed to upper endoscopy was significantly lower in the in-hospital bleeders compared to those who initially presented with AUGIB.

Research conclusions

In-hospital AUGIB is associated with a notably higher mortality and morbidity, as shown by higher rates of vasopressor use and extended LOS. Use of antiplatelets and/or anticoagulants obviously constituted a robust risk factor for in-hospital AUGIB. Interestingly, the shorter time to endoscopic therapy in inpatient bleeders did not seem to offset the higher morbidity and mortality noted in this group.

Research perspectives

To determine whether the above observation is related to increased comorbidities and antithrombotic use in in-hospital bleeders, larger scale studies are warranted to help confirm the intriguing findings of our study and shed more light on this important matter.