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DOI: 10.1055/a-1508-5871
Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial
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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References
- 1 Gralnek I, Dumonceau J-M, Kuipers E. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1-46
- 2 Hwang JH, Fisher DA, Ben-Menachem T. et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc 2012; 75: 1132-1138
- 3 Hwang JH, Shergill AK, Acosta RD. et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc 2014; 80: 221-227
- 4 de Franchis R. Expanding consensus in portal hypertension. J Hepatol 2015; 63: 743-752
- 5 Sey MSL, Mohammed SB, Brahmania M. et al. Comparative outcomes in patients with ulcer- vs non-ulcer-related acute upper gastrointestinal bleeding in the United Kingdom: a nationwide cohort of 4474 patients. Aliment Pharmacol Ther 2019; 49: 537-545
- 6 Lau JYW, Yu Y, Tang RSY. et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med 2020; 382: 1299-1308
- 7 Nahon S, Hagège H, Latrive JP. et al. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study. Endoscopy 2012; 44: 998-1008
- 8 Zeitoun J-D, Rosa-Hézode I, Chryssostalis A. et al. Epidemiology and adherence to guidelines on the management of bleeding peptic ulcer: a prospective multicenter observational study in 1140 patients. Clin Res Hepatol Gastroenterol 2012; 36: 227-234
- 9 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987; 40: 373-383
- 10 Rockall TA, Logan RF, Devlin HB. et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316-321
- 11 Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet Lond Engl 2000; 356: 1318-1321
- 12 Hearnshaw SA, Logan RFA, Lowe D. et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327-1335
- 13 Kaya E, Karaca MA, Aldemir D. et al. Predictors of poor outcome in gastrointestinal bleeding in emergency department. World J Gastroenterol 2016; 22: 4219
- 14 Maluf-Filho F, da Martins B C, de Lima MS . et al. Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer. United Eur Gastroenterol J 2013; 1: 60-67
- 15 Siau K, Hodson J, Ingram R. et al. Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United Eur Gastroenterol J 2019; 7: 199-209
- 16 Laursen SB, Leontiadis GI, Stanley AJ. et al. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017; 85: 936-944.e3
- 17 Villanueva C, Colomo A, Bosch A. et al. Transfusion Strategies for Acute Upper Gastrointestinal Bleeding. N Engl J Med 2013; 368: 11-21
- 18 Barkun AN, Bardou M, Kuipers EJ. et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-113
- 19 Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology 2011; 141: 62-70
- 20 Rosenstock SJ, Møller MH, Larsson H. et al. Improving Quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Cinical Register of Emergency Surgery. Am J Gastroenterol 2013; 108: 1449-1457
- 21 Sung JJY, Tsoi KKF, Ma TKW. et al. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol 2010; 105: 84-89
- 22 Bryant RV, Kuo P, Williamson K. et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013; 78: 576-583
- 23 Saltzman JR, Tabak YP, Hyett BH. et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011; 74: 1215-1224
- 24 Robertson M, Majumdar A, Boyapati R. et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016; 83: 1151-1160
- 25 Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M. et al. Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United Eur Gastroenterol J 2016; 4: 371-379