학술논문
Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort
Document Type
Clinical report
Author
Hajj, Weam; Quentin, Vincent; D' Hautefeuille, Gaelle Boudoux; Vandamme, Helene; Berger, Chantal; Moussaoui, Mohammed Redha; Berete, Aliou; Louvel, Dominique; Bertolino, Jean Guy; Cuillerier, Emmanuel; Thiebault, Quentin; Arondel, Yves; Grimbert, Sylvie; Guillou, Brigitte; Borel, Isabelle; Lahmek, Pierre; Nahon, Stéphane
Source
United European Gastroenterology Journal. July 2021, Vol. 9 Issue 6, p707, 11 p.
Subject
Language
English
Abstract
INTRODUCTION Upper gastrointestinal bleeding (UGIB) remains a common medical condition despite a decrease in its incidence by 23–33% over the last decades.[sup.1,2] Such decrease has been attributed to many factors [...]
: Objectives: Patients who develop upper gastrointestinal bleeding (UGIB) while in hospital appear to have a poor prognosis. Our study aims at analysing the difference in outcome between in‐patients (IPs) and out‐patients presenting with variceal and non‐variceal UGIB. Methods: We conducted a multicentre prospective study by collecting data about variceal and non‐variceal UGIB cases through 46 hospitals in France between November 2017 and October 2018. We then compared baseline demographic features, endoscopic findings and outcome between patients who developed variceal and non‐variceal UGIB on admission (OPs) and those at least 24 h after hospitalisation (IPs). Our primary end‐point was mortality and re‐bleeding rates at 6 weeks of bleeding onset. Results: A total of 2498 UGIB cases were identified, of whom 634 (25.4%) occurred in IPs. IPs were older than OPs (72.5 vs. 67.2 years old, p < 0.001) and had a higher rate of comorbidities (38.9% vs. 26.6%, p < 0.0001). Their bleeding was more severe with a Rockall score of >5 present in 40.9% (vs. 30.3% in OPs, p < 0.0001). The 6‐week mortality rate was significantly higher in IPs when compared to OPs (21.7% vs. 8%, p < 0.0001). Prothrombin time 11 (p = 0.017, 0.011 and 0.008, respectively). Conclusion: IPs who develop variceal and non‐variceal UGIB are more likely to be elderly with more comorbidities. They have a higher rate of mortality and rebleeding. Independent predictors of mortality were underlying coagulopathy and bleeding recurrence. An optimal bleeding management and efficient rebleeding prevention may improve outcome in these patients.
: Objectives: Patients who develop upper gastrointestinal bleeding (UGIB) while in hospital appear to have a poor prognosis. Our study aims at analysing the difference in outcome between in‐patients (IPs) and out‐patients presenting with variceal and non‐variceal UGIB. Methods: We conducted a multicentre prospective study by collecting data about variceal and non‐variceal UGIB cases through 46 hospitals in France between November 2017 and October 2018. We then compared baseline demographic features, endoscopic findings and outcome between patients who developed variceal and non‐variceal UGIB on admission (OPs) and those at least 24 h after hospitalisation (IPs). Our primary end‐point was mortality and re‐bleeding rates at 6 weeks of bleeding onset. Results: A total of 2498 UGIB cases were identified, of whom 634 (25.4%) occurred in IPs. IPs were older than OPs (72.5 vs. 67.2 years old, p < 0.001) and had a higher rate of comorbidities (38.9% vs. 26.6%, p < 0.0001). Their bleeding was more severe with a Rockall score of >5 present in 40.9% (vs. 30.3% in OPs, p < 0.0001). The 6‐week mortality rate was significantly higher in IPs when compared to OPs (21.7% vs. 8%, p < 0.0001). Prothrombin time 11 (p = 0.017, 0.011 and 0.008, respectively). Conclusion: IPs who develop variceal and non‐variceal UGIB are more likely to be elderly with more comorbidities. They have a higher rate of mortality and rebleeding. Independent predictors of mortality were underlying coagulopathy and bleeding recurrence. An optimal bleeding management and efficient rebleeding prevention may improve outcome in these patients.