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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1504-E1511
DOI: 10.1055/a-1508-5871
Original article

Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial

Vincent Quentin
1   Department of Gastroenterology, Centre Hospitalier (CH) de Saint-Brieuc, Saint-Brieuc, France
,
André-Jean Remy
2   Department of Gastroenterology, CH de Perpignan, Perpignan, France
,
Gilles Macaigne
3   Department of Gastroenterology, CH de Marne-la-Vallée, Marne-la-Vallée, France
,
Rachida Leblanc-Boubchir
4   Department of Gastroenterology, CH de Valenciennes, Valenciennes, France
,
Jean-Pierre Arpurt
5   Department of Gastroenterology, CH d’Avignon, Avignon, France
,
Marc Prieto
6   Department of Gastroenterology, CH de Meaux, Meaux, France
,
Carelle Koudougou
7   Department of Gastroenterology, CH de La Roche-sur-Yon, La Roche-sur-Yon, France
,
Laurent Tsakiris
8   Department of Gastroenterology, CH de Melun, Melun, France
,
Denis Grasset
9   Department of Gastroenterology, CH de Vannes, Vannes, France
,
René-Louis Vitte
10   Department of Gastroenterology, CH de Poissy, Poissy, France
,
David Cuen
11   Department of Gastroenterology, CH de Saint-Malo, Saint-Malo, France
,
Juliette Verlynde
12   Department of Gastroenterology, CH de Dunkerque, Dunkerque, France
,
Khaldoun Elriz
13   Department of Gastroenterology, CH de Corbeil, Corbeil, France
,
Marie-Pierre Ripault
14   Department of Gastroenterology, CH de Béziers, Béziers, France
,
Florent Ehrhard
15   Department of Gastroenterology, CH de Lorient, Lorient, France
,
Mathieu Baconnier
16   Department of Gastroenterology, CH d’Annecy, Annecy, France
,
Sofia Herrmann
17   Department of Gastroenterology, CH d’Orléans, Orléans, France
,
Nathalie Talbodec
18   Department of Gastroenterology, CH de Tourcoing, Tourcoing, France
,
You-Heng Lam
19   Department of Gastroenterology, CH de Cholet, Cholet, France
,
Karine Bideau
20   Department of Gastroenterology, CH de Quimper, Quimper, France
,
Laurent Costes
21   Department of Gastroenterology, CH de Créteil, Créteil, France
,
Florence Skinazi
22   Department of Gastroenterology, CH de Saint-Denis, Saint-Denis, France
,
Ivan Touze
23   Department of Gastroenterology, CH de Lens, Lens, France
,
Denis Heresbach
24   Department of Gastroenterology, CH de Pontivy, Pontivy, France
,
Pierre Lahmek
25   Department of Gastroenterology, CH de Limeil-Brévannes, Limeil-Brévannes, France
,
Stéphane Nahon
26   Department of Gastroenterology, CH de Montfermeil, Montfermeil, France
,
Members of the Association Nationale des Hépato-gastroentérologues des Hôpitaux Généraux (ANGH) SANGHRIA Study Group
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Abstract

Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first.

Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event.

Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1–4) and Rockall score was 5 (IQR 3–6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04–2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31–2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39–2.80), being an inpatient (OR 2.45; 95 %CI 1.76–3.41) and rebleeding (OR 2.6; 95 %CI 1.85–3.64). Anticoagulant therapy was not associated with dreaded outcomes.

Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.



Publication History

Received: 07 January 2021

Accepted: 05 May 2021

Article published online:
16 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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