Predictors of rebleeding and mortality in patients with high-risk bleeding peptic ulcers

Chi Liang Cheng, Cheng Hui Lin, Chia Jung Kuo, Kai Feng Sung, Ching Song Lee, Nai Jen Liu, Jui-Hsiang Tang, Hao Tsai Cheng, Yin Yi Chu, Yung Kuan Tsou

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Abstract

Background and Aim: Patients with bleeding ulcers can have recurrent bleeding and mortality after endoscopic therapy. Risk stratification is important in the management of the initial patient triage. The aim of this study is to identify the clinical and laboratory risk factors for recurrent bleeding and mortality. Methods: A prospective study was conducted in 390 consecutive patients with bleeding peptic ulcers and high-risk endoscopic stigmata, e.g., active bleeding, a non-bleeding visible vessel, adherent blood clot, and hemorrhagic dot. We tested 13 available variables for association with recurrent bleeding and 15 were tested for association with mortality. A logistic regression model was used to identify individual correlates associated with these adverse outcomes. Results: Bleeding recurred in 46 patients (11.8%) within 3 days and 21 patients (5.4%) had in-hospital mortality. In the full-factor analysis model, the incidence of recurrent bleeding was significantly higher in five of the 13 investigated variables and mortality was significantly higher in two of the 15 variables. In the final analysis model, significant risk factors for recurrent bleeding within 3 days, with adjusted odds ratios (OR), were in-hospital bleeding (OR 3.3), initial hemoglobin level <10 g/dl (OR 3.3) and ulcer ≥2 cm (OR 2.0). In-hospital bleeding was the only independent risk factor for mortality (OR 8.3). Conclusion: The study emphasizes the role of ulcer size, anemia and in-hospital bleeding as the determining high-risk predictors for adverse outcomes for bleeding peptic ulcers.

Original languageEnglish
Pages (from-to)2577-2583
Number of pages7
JournalDigestive Diseases and Sciences
Volume55
Issue number9
DOIs
Publication statusPublished - Sep 1 2010
Externally publishedYes

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Keywords

  • In-hospital bleeder
  • Logic regression model
  • Risk factors
  • Ulcer bleeding

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Cheng, C. L., Lin, C. H., Kuo, C. J., Sung, K. F., Lee, C. S., Liu, N. J., Tang, J-H., Cheng, H. T., Chu, Y. Y., & Tsou, Y. K. (2010). Predictors of rebleeding and mortality in patients with high-risk bleeding peptic ulcers. Digestive Diseases and Sciences, 55(9), 2577-2583. https://doi.org/10.1007/s10620-009-1093-9