Predicting Mortality in Non-Variceal Upper Gastrointestinal Bleeders: Validation of the Italian PNED Score and Prospective Comparison With the Rockall Score

Marmo, Riccardo; Koch, Maurizio; Cipolletta, Livio; Capurso, Lucio; Grossi, Enzo; Cestari, Renzo; Bianco, Maria Antonia; Pandolfo, N; Dezi, Angelo; Casetti, T.; Lorenzini, I.; Germani, Ugo; Imperiali, G; Stroppa, I.; Barberani, F.; Boschetto, S.; Gigliozzi, Alessandro; Gatto, G.; Peri, V.; Buzzi, A.; Casa, Domenico Della; Cicco, Marino Di; Proietti, M.; Aragona, Giovanni; Giangregorio, F.; Allegretta, Luciano; Tronci, Salvatore; Michetti, Paolo; Romagnoli, Paola; Piubello, W.; Ferri, B.; Fornari, Fabio; Piano, M. Del; Pagliarulo, M.; Mitri, Roberto Di; Trallori, Giacomo; Bagnoli, S; Frosini, G.; Macchiarelli, Raffaele; Sorrentini, I.; Pietrini, L.; Stefano, S. De; Ceglia, T.; Chiozzini, G; Salvagnini, M.; Muzio, Daniela Di; Rotondano, G.

doi:10.1038/ajg.2009.687

Cited by 148 publications

(121 citation statements)

References 23 publications

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“…The number of comorbidities was significantly higher in patients who died and it was an independent predictor of death (OR: 1.6; 95% CI: 1-2.5, p = 0.045). This finding is similar to that observed in other studies, particularly RUGBE and PNED studies (3,5,8). On the other hand, hypovolemic shock as cause of death was significantly higher in patients without comorbidities than in those with comorbidities (48 vs. 21%, p = 0.02).…”

Section: Discussionsupporting

confidence: 80%

“…Current evidence sug- gests that early administration of PPIs is the standard treatment of patients with NVUGB (20)(21)(22)(23)(24). The rebleeding rate observed in our patients (3.4%) was similar to that observed in the Italian PNED study (3.2%) and in other recent publications (17,18), but it was significantly lower than that reported in the Canadian RUGBE study (14.1%) (3,5,8). The divergence of our results from the ones of the Canadian study may be explained because a higher proportion of our patients received combined endoscopic therapy (adrenaline injection plus BICAP) than in the Canadian study; combined therapy has been shown to be superior to pharmacologic treatment for reduction of rebleeding in controlled trials (25)(26)(27).…”

Section: Discussionsupporting

confidence: 43%

“…Notwithstanding, Rockall scoring system has limitations due to the clinical and epidemiological differences observed in populations. Thus, despite the demonstrated utility of this scoring system, it is considered that there is currently no ideal method (8,31).…”

Section: Discussionmentioning

confidence: 99%

“…Age, gender, clinical manifestations of bleeding, history of prior gastrointestinal bleeding, use of tobacco and non-steroidal anti-inflammatory drugs (NSAIDs), and intake of alcohol were included in this database. Diabetes mellitus, cardiovascular disease (defined by the presence of hypertension, stroke or myocardial ischemia), chronic liver disease, chronic obstructive pulmonary disease and cancer were considered as severe comorbidities (3,8). In addition, hemodynamic instability, laboratory results on admission (serum hemoglobin, blood urea nitrogen, and blood albumin), number of units of blood transfused, the prescription of acid secretion blocking drugs (proton pump inhibitors or H2-receptor antagonists) were recorded.…”

Section: Predictors Of In-hospital Mortality In Patients With Non-varmentioning

confidence: 99%

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Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

González-González

Vázquez-Elizondo

García-Compeán

et al. 2011

Rev. esp. enferm. dig.

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Objective: to determine the independent predictors of in-hospital death of Hispanic patients with nonvariceal upper gastrointestinal bleeding (NVUGB).Experimental design: prospective and observational trial. Patients: in a period between 2000 and 2009, all patients with NVUGB admitted to our hospital were studied. Demographical and clinical characteristics, endoscopic findings and laboratory tests were evaluated. χ² and Mann-Whitney U analyses were performed for comparisons, and binary logistic regression was employed to identify independent predictors of in-hospital mortality.Results: 1,067 patients were included, 65% male with a mean age of 58.8 years. Mean number of comorbidities per patient was 1.6 ± 0.76. The most frequent cause of bleeding were gastric and duodenal ulcers (55.4%); 278 patients (25.8%) received endoscopic treatment of which 69.1% had combined therapy. Rebleeding occurred in 36 patients (3.4%) of which 50% died. Inhospital mortality was 10.2%, of which only 3.1% was associated to bleeding. When comparing causes of death among patients with and without comorbidities, only hypovolemic shock was found significative (48.3 vs. 25%; p = 0.020). Binary logistic regression found that the number of comorbidities, Rockall scale serum albumin < 2.6 g/dL on admission; rebleeding and length of hospital stay were independent risk factors of in-hospital mortality.Conclusion: the number of comorbidities, the Rockall scale score, an albumin level < 2.6 g/dL, the presence of rebleeding and hospital stay were predictors of in-hospital mortality in patients with UNVGB. INTRODUCTIONNon-variceal upper gastrointestinal bleeding (NVUGB) is a critical condition in which a mortality of 5 to 10% has been reported in different series of patients. This variability may be explained in part by the different clinical and demographic characteristics of the studied population (1,2). Recent prospective studies have identified different predictors of mortality; it is worth noting that the use of proton pump inhibitors (PPIs) significantly reduces mortality in patients both with and without high risk stigmata of rebleeding. Moreover, the use of endoscopic treatment has been demonstrated to reduce mortality in greater proportion than drug treatment (3-6). However, it has been shown that the risk factors, complications and mortality rates described in controlled trials are lower than those reported in patients who received their attention on "day-today conditions" in a tertiary care community hospital (7), which illustrates more accurately the actual conditions of medical care.The main objective of our study is to describe the clinical characteristics, endoscopic findings, and treatment used, as well as risk factors of complications and in-hospital mortality in Hispanic patients with NVUGB on "day-to-day conditions". Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleedingJosé Alberto González-González, Genaro Vázquez-Elizondo, Diego García-Compeán, Juan Obed Gaytán-Torres, Ángel Ricardo ...

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Predictors Of In-hospital Mortality In Patients With Non-varmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

González-González

Vázquez-Elizondo

García-Compeán

et al. 2011

Rev. esp. enferm. dig.

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“…An Italian score of 10, the PNED score [21] , was developed and validated to predict 30 d mortality after non-variceal bleeding. The PNED score is based on ten variables, (8 clinical and 2 laboratorial), and ranges from 0 to 24 (Table 4).…”

Section: Clinical and Endoscopic Scoresmentioning

confidence: 99%