Factors predicting mortality of elderly patients with acute upper gastrointestinal bleeding
, , , , , , , , , , , , , , and | Jan 31, 2017
About this article
Article Category: Original article
Published Online: Jan 31, 2017
Page range: 115 - 122
DOI: https://doi.org/10.5372/1905-7415.1002.471
Keywords
© 2016 Thirada Thongbai, Kessarin Thanapirom, Wiriyaporn Ridtitid, Rungsun Rerknimitr, Rattikorn Thungsuk, Phadet Noophun, Chatchawan Wongjitrat, Somchai Luangjaru, Padet Vedkijkul, Comson Lertkupinit, Swangphong Poonsab, Thawee Ratanachu-ek, Piyathida Hansomburana, Bubpha Pornthisarn, Varocha Mahachai, Sombat Treeprasertsuk
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Clinical outcomes of elderly patients presenting with acute upper gastrointestinal bleeding
| Variable | N = 499 |
|---|---|
| Endoscopic therapy for bleeding peptic ulcer: n | |
| Epinephrine injection | 89 |
| Coaptive thermocoagulation | 47 |
| Hemoclip | 28 |
| Combined therapy | 70 |
| Endoscopic therapy for variceal bleeding: n | |
| Endoscopic band ligation | 35 |
| Cyanoacrylate injection | 9 |
| Hospital stay: days | 13.9 |
| Rebleeding within 30 days: n (%) | 5 (1%) |
| In hospital mortality: n (%) | 17 (3.4%) |
| 30-day mortality: n (%) | 45 (9%) |
| Surgery or intervention: n (%) | 6 (1.2%) |
Characteristics of 499 elderly patients presenting with acute upper gastrointestinal bleeding
| Variable [number (%) or mean ± SD] | Total (n = 499) |
|---|---|
| Age (year) | 71.6 ± 7.65 |
| Male: n (%) | 300 (60.1%) |
| Presenting symptom: n (%) | |
| Hematemesis | 250 (50.1%) |
| Melena | 221 (44.3%) |
| Hematochezia | 28 (5.6%) |
| Clinical findings: n (%) | |
| Pulse rate >100 beats/min | 26 (5.2%) |
| Systolic blood pressure <100 mmHg | 26 (5.2%) |
| Presence of hemodynamic instability | 71 (14.2%) |
| (pulse >100 bpm and systolic blood | |
| pressure <100 mmHg) | |
| Nasogastric lavage findings: n (%) | |
| Red blood on nasogastric lavage | 60 (12%) |
| “Coffee grounds” | 181 (36.3%) |
| Normal content | 144 (28.8%) |
| No nasogastric lavage | 114 (22.8%) |
| Concomitant illness | |
| Diabetes mellitus | 125 (25%) |
| Hypertension | 220 (44%) |
| Cardiovascular disease | 44 (8.8%) |
| Chronic renal failure | 37 (7.4%) |
| Cirrhosis | 56 (11.2%) |
| Alcohol drinking: n (%) | 73 (14.6%) |
| Smoking: n (%) | 80 (16%) |
| Previous use of medication: n (%) | |
| Low-dose aspirin | 86 (17.2%) |
| Non-steroidal anti-inflammatory drugs | 77 (15.4%) |
| Warfarin | 9 (1.8%) |
| Clopidogrel | 13 (2.6%) |
| Laboratory features at presentation | |
| Hemoglobin (g/dL) | 8.70 ± 3.3 |
| White blood count (103/μL) | 11.6 ± 12.9 |
| Platelets (103/μL) | 218.7 ± 115.5 |
| International normalized ratio of prothrombin time | 1.2 ± 0.8 |
| Blood urea nitrogen (mg/dL) | 32.8 ± 23.1 |
| Creatinine (mg/dL) | 1.7 ± 1.5 |
| Blood transfusion | |
| Pack red cell: n (%) | 354 (70.9%) |
| Fresh frozen plasma: n (%) | 58 (11.6%) |
| Platelets: n (%) | 35 (7%) |
| Proton pump inhibitor: n (%) | |
| Oral route | 25 (5%) |
| Intravenous bolus | 392 (78.5%) |
| Intravenous continuous drip | 72 (14.4%) |
Endoscopic findings in 499 elderly patients presenting with acute upper gastrointestinal bleeding
| Variable | Total (n = 499) |
|---|---|
| Peptic ulcer as source of bleeding: n (%) | |
| Clean base | 263 (52.7%) |
| Pigment spot | 37 (7.4%) |
| Adherent clot | 8 (1.6%) |
| Nonbleeding visible vessel | 51 (10.2%) |
| Bleeding visible vessel | 36 (7.2%) |
| Variceal bleeding as source of bleeding: n (%) | |
| Esophageal varices (EV) | 41 (8.2%) |
| Gastric varices (GV) | 2 (0.4%) |
| EV and GV | 16 (3.2%) |
| Portal hypertensive gastropathy | 46 (9.2%) |
| Other Endoscopic findings (%) | |
| Mallory–Weiss tear | 8 (1.6%) |
| Esophagitis | 19 (3.8%) |
| Ulcerative mass | 5 (1%) |
| Gastroduodenitis | 136 (27.2%) |
| Angiectasia | 3 (0.6%) |
| No lesion identified | 3 (0.6%) |
Rockall score stratification into 3 groups with percentage of rebleeding and mortality of elderly patients presenting with acute upper gastrointestinal bleeding
| Group | Score | Cases (%) | Rebleeding (%) | Mortality (%) |
|---|---|---|---|---|
| Low-risk | <3 | 244 (48.9%) | 1 (0.2%) | 21 (8.6%) |
| Moderate-risk | 3-4 | 199 (39.9%) | 3 (0.60%) | 18 (9.0%) |
| High-risk | >4 | 56 (11.2%) | 1 (0.2%) | 6 (11%) |
Predictor of 30-day mortality by univariate analysis (continuous variables) of 499 elderly patients presenting with UGIB
| Predictors | Death (n = 45) | Survival group (n = 454) | |
|---|---|---|---|
| Mean age (± SD) in years | 74.1 ± 7.3 | 71.4 ± 7. 7 | 0.01 |
| Hemoglobin (g/dL) | 9.7 ± 5.5 | 8.6 ± 3 | 0.02 |
| Platelet count | 213.9 ± 134.1 | 219.2 ± 113.6 | 0.38 |
| International normalized ratio of prothrombin time | 1.4 ± 1.3 | 1.2 ± 0 . 8 | 0.06 |
| Blood urea nitrogen | 40.7 ± 23.6 | 32 ± 22.9 | 0.008 |
| Creatinine (mg/dL) | 2.5 ± 2.1 | 1.6 ± 1 . 5 | 0.004 |
| Rockall score | 2.9 ± 1.7 | 2.7 ± 1.5 | 0.4 |
Predictors of 30 day mortality of 499 elderly patients presenting with acute upper gastrointestinal bleeding on univariate analysis (categorical variables)
| Predictors | No. of deaths/No. of patients with predictors | No. of deaths/No. of patients without predictors | Odds Ratio (95% CI) | |
|---|---|---|---|---|
| Coronary artery disease | 8/44 (18%) | 37/455 (8%) | 0.048 | 2.49 (1.1 -5.7) |
| Chronic kidney disease | 7/37 (19%) | 38/462(8%) | 0.03 | 2.58 (1.1 -6.3) |
| Presence of hemodynamic instability | 12/62 (19%) | 33/437 (8%) | 0.003 | 2.9 (1.4 -5.9) |
| (pulse >100 bpm and SBP <100 mmHg) | ||||
| Pulse rate >100 bpm | 8/26 (31%) | 37/473 (8%) | 0.001 | 5.19 (2.1-12.7) |
| Red blood in NGT | 18/60 (30%) | 27/43 (6%) | <0.001 | 6.48 (3.3-12.7) |
| FFP transfusion | 11/58 (19%) | 34/441 (8%) | 0.006 | 2.73 (1.3 -5.7) |
| EV and GV finding | 4/16 (25%) | 41/433 (10%) | 0.048 | 3.56 (1.1-11.5) |
| Cyanoacrylate glue injection | 4/9 (44%) | 41/490 (8%) | 0.005 | 8.68 (2.2-33.6) |
Independent predictors of 30 day mortality (logistic regression analysis)
| Predictors | Odds Ratio | 95% CI | |
|---|---|---|---|
| Pulse rate >100 beats/min | 0.019 | 3.91 | 1.2–12.2 |
| Red blood in nasogastric tube | <0.001 | 5.44 | 2.3–12.6 |
| Creatinine more than 1.5 | 0.002 | 3.13 | 1.5–6.5 |
| Coronary artery disease | 0.028 | 3.27 | 1.1–9.4 |