In-hospital acute upper gastrointestinal bleeding: what is the scope of the problem?

Abstract

BACKGROUNDAcute upper gastrointestinal bleeding (AUGIB) is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%. Despite recent newer innovations and advancements in endoscopic techniques and available medications, the mortality rate associated with AUGIB remained persistently elevated.AIMTo explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.METHODSThis is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically. Patients 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.RESULTSA 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, number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1. Inpatients were more likely to be on corticosteroids, antiplatelets and anticoagulants. Conversely, the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.CONCLUSIONIn-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy. Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.

Comparison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding

“…In our study, 15% of hospitalised patients who develop UGIB died within the 30 days of bleeding onset. This very high mortality rate is consistent with previous studies examining similar patients, 11,12,15,16 and more than twice as high as community‐based patients presenting to hospital with UGIB 7,9 . The difference in mortality is probably due to hospitalised patients who develop UGIB being older and more comorbid, both of which are strong predictors of mortality 4,7,11,12 .…”

“…Compared to patients presenting to hospital with UGIB these patients are generally older, more comorbid, have higher use of anti‐thrombotic agents and their death rate is almost five times higher. The aetiology of bleeding also differs, with stress ulcers caused by splanchnic hypoperfusion from systemic hypotension in critical illness a common cause 10‐16 . These characteristic differences indicate UGIB risk assessment scores may not be generalisable to hospitalised patients who develop UGIB.…”

Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort

“…Our observation is in agreement with previous studies where mortality rate in IPs was estimated between 9% and 39% and IP/OP mortality ratio between 2.3-and 6-fold. [5][6][7][8][9] Rebleeding rate at 6 weeks was also significantly elevated in IPs, a finding, that is, however, in contrast with the majority of other similar studies that did not observe any considerable increase in bleeding Abbreviations: CI, confidence interval; GBS, Glasgow-Blatchford score; Hb, haemoglobin; OR, odds ratio; Pre-RS, pre-endoscopic Rockall Score; PT, prothrombin time.…”

“…UNITED EUROPEAN GASTROENTEROLOGY JOURNAL recurrence among IPs [6][7][8][9] except for the study of Jairath et al 5 who noticed a 2-fold higher odds of rebleeding in IPs versus OPs. Perhaps, in our study, the longer follow-up period of 6 weeks rather than 28 days and the inclusion of variceal haemorrhage in addition to the non-variceal bleeding have allowed us to detect more rebleeding cases.…”

Predictors of mortality in upper gastrointestinal bleeding in patients already hospitalized for another condition: a prospective study.

“…En nuestra serie, el 42% de los pacientes hospitalizados que desarrollaron una HDA fallecieron durante el episodio agudo, tanto por razones relacionadas directamente con la hemorragia como por situaciones de fallo multiorgánico, enfermedades cardiopulmonares descompensadas, etc. ; una tasa más alta que la reportada en otros estudios 2,3,4,5,6 . Esto probablemente se deba a que son pacientes más enfermos con lo que podríamos apoyar la teoría de que la causa de muerte puede estar más en relación con sus enfermedades de base y no directamente por causas derivadas del episodio de HDA.…”