THE USE OF A SPECIALIZED BLEEDING-MANAGEMENT TEAM HAD NO IMPACT ON MORTALITY FOR ACUTE UPPER GASTROINTESTINAL BLEEDING (AUGIB): AN ITALIAN PROSPECTIVE MULTICENTER COHORT STUDY

Aims Aim of the study was to verifiy if patients with AUGIB, treated by a BT had better survival in comparison with patients not treated by a BT.

Methods Data on patients admitted for AUGIB were collected from January 1^st,2014 to December 31^st,2015. Bleeding-related death was defined as any event occurring within30 days from admission for non-variceal bleeding and within 42 days for variceal bleeds.

Results Out of 3324 AUGIB enrolled,2088 patients (62.8%) were admitted in hospitals without a BT facility. 2764 (83.1%) had non-variceal bleeding(NV-AUGIB);of these 1817(65.7%) were admitted to hospitals without BT.560 patients had variceal bleeding(V-AUGIB); of these 271(48.4%)were admitted to hospitals without BT.Endoscopic therapy was performed more frequently in hospitals with BT in both NV-AUGIB 561/947(59.2%) vs 855/1817(47.1%) p < 0.001 and V-AUGIB 278/289(96.2%) vs. 247/271(91.1%) p < 0.01.The death rate in the patients undergoing endoscopic treatment in hospitals with BT 33/561(5.8%) or without 53/855(6.2%) p = 0.90 was similar both in NV and V -AUGIB 30/271(11.1%) vs 37/289(12.8%) p = 0.53.By multiple logistic regression, factors significantly affecting mortality were age, (O.R 1.03 [95% CI < 1.01 to 1.04]; p < 0.001); variceal bleeding(O.R. 1.94 [95% CI1.30 to 2.90] p < 0.001) need for transfusions (OR 1.45 [95% CI 1.13 to 1.85] p < 0.003);rebleeding (OR14.9 [95% CI 0.58 to 21.02] p < 0.000). Presence of a Bleeding Team (OR 1.24 [95% CI 0.91 to 1.69] p < 0.17) did not impact on survival.

Conclusions The majority of the patients with AUGIB was admitted to Hospitals without BT.The endoscopic treatment was delivered in a high proportion of patients in all Hospitals. The presence of a BT did not impact on survival in both NV and V – AUGIB.