Jairath Vipul, Martel Myriam, Logan Richard F A, Barkun Alan N
Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
Can J Gastroenterol. 2012 Aug;26(8):537-43. doi: 10.1155/2012/862905.
Discrepancies exist in reported mortality rates of nonvariceal upper gastrointestinal bleeding (NVUGIB).
To perform a systematic review assessing possible reasons for these disparate findings and to more reliably compare them.
The MEDLINE, EMBASE and ISI Web of Knowledge databases were searched for studies reporting mortality rates in NVUGIB involving adults and published in English. To ensure robust and contemporary estimates, studies spanning 1996 to January 2011 that included more than 1000 patients were selected.
Eighteen of 3077 studies were selected. Ten studies used administrative databases and the remaining eight used registries. The mortality rates reported in these studies ranged from 1.1% in Japan to 11% in Denmark. There were variations in reported mortality rates among countries and also within countries. Reasons for these disparities included a spectrum of quality in reporting as well as heterogeneous definitions of case ascertainment, differing patient populations with regard to severity of presentation and associated comorbidities, varying durations of follow-up and different health care system-related practices.
Wide differences in reported NVUGIB mortality rates are attributable to differences in adopted methodologies and populations studied. More uniform standards in reporting are needed; only then can true observed variations enable a better understanding of causes of death and pave the way to improved patient outcomes.
非静脉曲张性上消化道出血（NVUGIB）的报告死亡率存在差异。
进行一项系统评价，评估这些不同研究结果的可能原因，并更可靠地对其进行比较。
检索MEDLINE、EMBASE和ISI Web of Knowledge数据库，查找报告NVUGIB成年患者死亡率且以英文发表的研究。为确保得出可靠且最新的估计值，选取了1996年至2011年1月期间纳入超过1000例患者的研究。
从3077项研究中选取了18项。10项研究使用行政数据库，其余8项使用登记处数据。这些研究报告的死亡率从日本的1.1%到丹麦的11%不等。各国之间以及同一国家内部报告的死亡率均存在差异。这些差异的原因包括报告质量参差不齐、病例确定的定义不统一、患者群体在病情严重程度和相关合并症方面存在差异、随访时间不同以及与医疗保健系统相关的做法各异。
报告的NVUGIB死亡率差异较大，这归因于所采用方法和研究人群的不同。需要更统一的报告标准；只有这样，真实观察到的差异才能有助于更好地理解死亡原因，并为改善患者预后铺平道路。
