Risks for Rebleeding and In-Hospital Mortality after Gastrointestinal Bleeding in a Tertiary Referral Center in Japan

Abstract

<b><i>Background:</i></b> Gastrointestinal bleeding (GIB) is one of the most common medical emergencies. We investigated the overall mortality after GIB in our institute and analyzed the prognostic factors in upper GIB (UGIB) and lower GIB (LGIB) separately. <b><i>Summary:</i></b> Between January 2010 and December 2018, 190 patients diagnosed with GIB in our hospital were retrospectively enrolled. Clinical records and biological data were collected. Risks for rebleeding and in-hospital mortality were assessed by a logistic regression analysis. Overall, the rebleeding rate and in-hospital mortality were 22.6 and 7.6%, respectively. GIB itself was not the direct cause of death in any cases. While older age (>65 years) was a significant risk factor for rebleeding in UGIB with an OR of 6.1 and 95% CI of 1.3–29.1, a poorer performance status (PS; ≥3) was a strong risk factor for rebleeding in LGIB, with an OR of 11.8 and 95% CI of 1.7–83.8. Poor PS and tachycardia (>100/min) were significantly associated with mortality in both UGIB and LGIB. In contrast, hypoalbuminemia (<3.0 g/dL) was associated with the mortality in LGIB alone. <b><i>Key Messages:</i></b> There were considerable differences in the risk factors for rebleeding and in-hospital mortality between UGIB and LGIB. The overall in-hospital mortality was 7.9% after GIB, including that a substantial portion of patients with GIB died from systemic complications after successful endoscopic hemostasis. Physicians need to diligently perform systematic treatment for GIB, which may be particularly important in societies of advancing aging, like Japan.

Incidence, predictors, and clinical impact of bleeding recurrence in patients with prior gastrointestinal bleeding undergoing LAAC

“…Lower GIB (versus upper or unclassified) and moderate‐to‐severe CKD (eGFR < 45 mL/min) determined an increased risk of GIB recurrence. In all‐comer patients with prior GIB, the recurrent bleeding rate in lower GIB has been reported to be significantly higher compared to upper GIB episodes 18 . In addition, the risk of GIB increases as eGFR decreases, 19 and CKD has already been associated with an increased risk of bleeding recurrence in patients with prior obscure GIB (with or without AF) 20 .…”

Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

“…In addition, such unfavorable outcome can be also caused by hemodynamic instability due to UGIB. Actually, a cohort study of emergency admissions for nonmalignant UGIB reported that 8.9% of deaths after 30 days of hospitalization were due to ischemic heart disease and the cardiovascular age-standardized mortality rate following UGIB was high [42]. Another study examining the risk of rebleeding and in-hospital mortality after UGIB demonstrated that 1.5% of patients with UGIB died of thromboembolism, and poor performance status (PS; ≥3) and tachycardia (>100/min) were significantly associated with mortality [40].…”

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

“…Gastrointestinal (GI) bleeding (GIB) is one of the most frequent causes of morbidity and mortality worldwide, with annual hospitalization rates of about 150 patients per 100,000 population and an annual mortality rate of 7%-10% [1][2][3]. Endoscopic hemostasis is the first choice approach and gold standard treatment for GIB.…”

“…Endoscopic hemostasis is the first choice approach and gold standard treatment for GIB. Conventional hemostatic procedures (CHP) include (i) injection agents, (ii) contact thermal devices such as heater probes, multipolar electrocautery probes, (iii) non-contact thermal devices such as argon plasma coagulation (APC), (iv) mechanical devices including hemostatic graspers, band ligators, clips, and loops, and (v) topical agents [3]. Efficacy of endoscopic hemostasis ranges from 67% to 100%, with a re-bleeding rate of 10%-30% [2,3].…”