Factors predicting mortality of elderly patients with acute upper gastrointestinal bleeding

Abstract

Background: Acute upper gastrointestinal bleeding (UGIB) is a common gastrointestinal disease emergency and a cause of morbidity and mortality. Objectives: To assess the clinical outcomes and explore predictive factors for mortality of elderly patients with acute UGIB. Methods: During the study period from January 2010 to September 2011, we prospectively enrolled 981 patients presenting with UGIB from 11 hospitals (mean age ± standard deviation (SD), 59.4 ± 14.9 years; range, 17−94 years; including 661 men). Of these 981 patients, 499 (50.9%) were elderly. Basic demographic data and clinical findings, and Rockall scores were collected and calculated. Results: We studied 499 elderly patients. Their mean age ± SD was 71.63 ± 7.65 years. The 30-day mortality rate was 9% and rebleeding was just 1%. Regression analysis showed a pulse rate >100 beats per min at first visit, red blood in a nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL were independent predictive factors of 30-day mortality. Conclusions: Peptic ulcer bleeding is a major cause of acute UGBI in the elderly. We recommend patients with predictive factors of mortality, pulse rate >100 beats per min at first visit, red blood in nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL be closely monitored and treated promptly. Reducing mortality from peptic ulcer bleeding should focus on preventing peptic ulcer occurrence as a result of ulcerogenic medications.

Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding

“…On the contrary to our results, bleeding peptic ulcer was reported as the main source of UGIB among elderly in several studies: Thongbai et al [ 3 ] stated that the most common cause of acute UGIB was peptic ulcer bleeding which accounted for 84.8% of UGIB in their elderly patients. Also Charatcharoenwitthaya et al [ 12 ] found that 68% of acute UGIB was derived from bleeding peptic ulcers which were attributed to increase prescribing of potentially ulcerogenic drugs.…”

“…Similar result was obtained by Nahon et al [ 17 ] who revealed that in-hospital mortality rate of the elderly was 8.93%. On the other hand, low mortality rate of 3.41% was reported in a study of Thongbai et al [ 3 ] who attributed that to small number of cirrhotic portal hypertensive patients (11.22%)—who carried a higher risk of mortality—included in their study.…”

“…Despite significant advances in diagnosis and treatment of UGIB, mortality rate in elderly is still increasing. [ 3 ] This is probably due to increased frailty, less tolerability of the elderly to hemodynamic changes resulting from acute bleeding episodes, underlying co-morbidities, as well as concomitant use of multiple medications. [ 4 ]…”

Predicting mortality from upper gastrointestinal bleeding

“…Thongbai et al [1] have conducted a multicenter study from 11 hospitals in Thailand and identify predictors of 30 day mortality among the elderly. These include a pulse rate of more than 100 beats per minute at first visit, red cells in nasogastric aspiration, existing coronary heart disease, and creatinine of >1.5 mg/dL.…”

“…All the existing scores including the predictors suggested by Thongbai et al [1] need to be validated in appropriate populations to guide treatment, reduce the length of hospital stay and the cost associated with treatment, and the rate of admission.…”