Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2687-2703
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2687
Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding
Daniela Cornelia Lazăr, Sorin Ursoniu, Adrian Goldiş
Daniela Cornelia Lazăr, Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
Sorin Ursoniu, Department of Public Health and Health Management, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
Adrian Goldiş, Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
Author contributions: All the authors contributed equally to this work.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University of Medicine and Pharmacy “Victor Babeş”, Timişoara.
Informed consent statement: Patients were not required to give informed consent for the study because the analysis was retrospective, and it used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which 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: Daniela Cornelia Lazăr, MD, PhD, Senior Lecturer, Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Piata Eftimie Murgu No. 2, Timişoara 300041, Timiş County, Romania. lazar.daniela@umft.ro
Telephone: +40-256-220484 Fax: +40-256-220484
Received: June 25, 2019
Peer-review started: June 25, 2019
First decision: July 20, 2019
Revised: August 16, 2019
Accepted: August 27, 2019
Article in press: August 26, 2019
Published online: September 26, 2019
Processing time: 91 Days and 12.1 Hours
Abstract
BACKGROUND

Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high.

AIM

To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management.

METHODS

We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death; we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB.

RESULTS

We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%; surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases; the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death; comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03).

CONCLUSION

Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for in-hospital mortality.

Keywords: Nonvariceal upper digestive bleeding; Risk factors; Rebleeding; Death; Outcome

Core tip: Because the rate of morbidity and mortality in patients with nonvariceal upper digestive bleeding (NVUDB) remains high, our retrospective study aims to identify clinical and paraclinical parameters associated with the risk of rebleeding and death in these patients. Our data showed that the Rockall score was associated with both rebleeding and death. The presence of comorbidities was associated with an increased risk of in-hospital mortality; among them, sepsis was associated with the highest risk. Identification of the risk factors for poor outcomes in patients with NVUDB proved to be associated with an improvement in management and, subsequently, in patient outcomes.