Dr Riccardo Marmo and colleagues from Italy assessed the clinical outcomes and explored the roles of clinical, endoscopic, and therapeutic factors on 30-day mortality in a real life setting.
The research team used data from an Italian Registry of patients with upper gastrointestinal hemorrhage.
The team undertook a prospective analysis of consecutive patients endoscoped for upper gastrointestinal hemorrhage at 23 community and tertiary care institutions from 2003 to 2004.
Covariates and outcomes were defined a priori and 30-day follow-up data were obtained.
Logistic regression analysis identified predictors of mortality.
The researchers evaluated 1021 patients.
|35% of patients died within the first 24 hours of the onset of bleeding|
|American Journal of Gastroenterology|
A total of 46 patients died for an overall 5% mortality rate.
In all, 85% of deaths were associated with 1 or more major comorbidity.
The researchers found that 35% of patients died within the first 24 hours of the onset of bleeding.
Of these, 8 had been categorized as ASA class 1 or 2, and none of them was operated upon, despite a failure of endoscopic intention to treatment in 4.
The team showed that advanced age, presence of severe comorbidity, and low hemoglobin levels at presentation were independent predictors of 30-day mortality.
The research team identified worsening health status as the only other independent predictor of 30-day mortality.
The acute use of a proton pump inhibitor exerted a protective effect.
Recurrent bleeding was low, occurring in 3% of patients.
The researchers observed that rebleeders accounted for only 11% of the total patients deceased.
Dr Marmo's team commented, "These results indicate that 30-day mortality for nonvariceal bleeding is low."
"Deaths occurred predominantly in elderly patients with severe comorbidities or those with failure of endoscopic intention to treatment."