Aims:
Peptic ulcer bleeding (PUB) is the most common cause of upper gastrointestinal bleeding. The aim of this study is to evaluate the impact of comorbidities and advanced age on in-hospital mortality in PUB patients.
Methods:
In the present study patients presenting to the emergency department of a tertiary care center with PUB were included throughout an 18-month period. The following variables, with possible influence on the mortality rate, were analyzed: demographic data, clinical parameters (hypotension, tachycardia, the presence and characteristics of hematemesis, the presence of melena or hematochesia), use of NSAIDs, antiplatelets or anticoagulants, the severity of anemia and the need for transfusion, the level of ureea and INR, the endoscopic aspect of the ulcers (high-risk stigmata and low-risk stigmata) and comorbidities (no comorbidity, single comorbidity and multiple or severe comorbidity).
Results:
431 patients were included in the study. The patients had a mean age of 63.07 years, 11.8% of them having over 80 years. The study population showed a male predominance (69.1%). In-hospital mortality rate was 7.9%. Comparing the patients who have died with the ones who have survived we observed the following significant differences: age over 80 years 32.4% vs. 10.1% (p < 0.001); hypotension 17.6% vs. 2.3% (p < 0.001); tachycardia 47.1% vs. 21.4% (p = 0.001); hemoglobin (g/dl) 7.88 ± 2.78 vs. 9.61 ± 2.78 (p < 0.001); need for transfusion (blood units) 4 (1; 6) vs. 1 (0; 3) (p < 0.001); ureea (mg/dl) 122 (81; 163) vs. 76 (52; 110) (p < 0.001); INR 1.45 (1.15; 1.80) vs. 1.17 (1.07; 1.37) (p = 0.001); high risk of endoscopic lesions 79.4% vs. 62.2% (p = 0.049); multiple or severe comorbidity (88.2% vs. 34.2%) (p < 0.001). Four factors were independently associated, with patients’ death: the presence of multiple or severe co-morbidities (HR = 6.49, 95% CI: 1.41 – 29.21; p = 0.016), age over 80 years (HR = 5.17, 95% CI: 1.90 – 14.04; p = 0.001), tachycardia (HR = 2.51, 95% CI: 1.00 – 6.22; p = 0.048) and the needs for transfusion (HR = 1.26, 95% CI: 1.07 – 1.47; p = 0.020).
Conclusions:
The presence of multiple or severe comorbidities, age over 80 years, tachycardia at admission and the need for transfusion were significantly associated with in-hospital mortality.
