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Factor Associated with Mortality from Non Variceal Upper Gastrointestinal Bleeding (UGIB) in Italy: A Nationwide Prospective Study

2007; Elsevier BV; Volume: 65; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2007.03.923

1097-6779

Riccardo Marmo, M. Koch, Livio Cipolletta, Lucio Capurso, G. Rotondano, Maria Antonietta Bianco, Angelo Dezi, A. Pastorelli, Elena Torre, I. Lorenzini, Lisa Girardi, Paola Romagnoli, Domenico Della Casa, A. Buzzi, R. Fasoli, Sergio Brunati, Ugo Germani, G. Di Matteo, P. Di Giorgio, G. Imperiali, Giorgio Minoli, F. Barberani, S. Boschetto, G. Gatto, M. Amuso,

Gastrointestinal disorders and treatments

Background: The death is the most relevant outcome for any study. The death from non-variceal UGIB may occur in particular if advanced age and life-threatening co-morbidities are present. Other factors i.e endoscopic and pharmacological treatment, timing of endoscopy are not yet recognized as having prognostic impact. Aim: assess the mortality rate from nonvariceal UGIB and identify clinical, endoscopic and therapeutic prognostic factors of mortality. Methods: A multicentre, prospective database study was carried out in 23 hospitals receiving emergency admissions. Outcome measure was 30-day mortality. Results: Over a 12 months period a total of 1020 patients with non variceal UGIB were entered in a national database and analysed. Peptic ulcer bleeding accounted for 66% of the cases. Ulcerogenic co-prescriptions were recorded in 51.4% of patients. One or more comorbidities were recorded at the time of presentation in 53% of cases. Overall mortality was 4.5% [95% CI 3.3-6.0] (46/1020). In all, 39/46 (85%) deaths were associated with one or more major comorbidities. Sixteen patients (34,8% [95% CI 22.1-49.3) died within the first 24 hours of the onset of bleeding, with 10 patients deceased within 8 hours of the endoscopic examination. Nine patients had been categorised as ASA class III or IV whereas 7 patients as ASA class I or II and none of them was operated upon. In four of them there had been a failure of endoscopic haemostasis. For the remaining 30 patients, death occurred within 7 days in 50% and within 12 days in 75% of cases. Factors associated with increased risk of mortality were advanced age 76,6 ± 14,0 (p = 0.000), low diastolic pressure 66,3 ± 15,2 (p = 0.001), presence of severe comorbidity, use of nitrates (OR 4.0 [95% CI 1.9-8.8]), presence of blood in gastric cavity hampering endoscopic diagnosis (OR 14.7 [95% 4.6-46.9]), failure of endoscopic haemostasis (OR 72.9 (95% CI 14.2 - 372.5), recurrent bleeding (OR 4,12 [95% CI 1.5-11.2]), no PPI use after endoscopic therapy (OR 4.28 [95% CI 1.36-11.34]) and transfusion requirements (OR 2,67 [95% CI 1.46-4.85]). Conclusions: overall mortality from non variceal UGIB in Italy is low (4.5%). Deaths occurred almost exclusively in elderly patients with severe co-morbidities, independently of the type of endoscopic treatment delivered. Between the endoscopic findings, the presence of blood in the gastric cavity hampering the diagnosis and endoscopic therapy failure are, over all, the most relevant prognostic factor for death. Prompt resort to surgery should be considered for surgically fit patients in whom endoscopy therapy fails to treat the stigmata in the first 24 hours.