Department of Medicine, MedStar Washington Hospital Center, 110 Irving St, NW Suite 3A3-A7, Washington, DC, 20010-2975, USA.
Dig Dis Sci. 2013 Oct;58(10):2940-8. doi: 10.1007/s10620-013-2765-z. Epub 2013 Jul 5.
Upper gastrointestinal bleeding (UGIB) causes over $1 billion in medical expenses annually.
The purpose of this study was to examine changes of UGIB mortality risks and trends over the last three decades.
We analyzed the National Hospital Discharge Sample from 1979 to 2009. Patients with primary ICD-9 code representing a diagnosis of UGIB were included. The UGIB mortality risks and trends in each decade by anatomical sites, bleeding causes, comorbidities, and other important variables were analyzed.
UGIB mortality risk decreased by 35.4 % from 4.8 % in the first decade to 3.1 % in the third decade (P < 0.001). Age and number of hospitalization days were significant risk factors in all decades. Most significant decreases were observed in patients over 65 years and during the first day of admission. Gastric (P < 0.001) and esophageal (P = 0.018) bleedings showed significant decreasing mortality risk trends. Duodenal bleeding mortality risk was stable in three decades. Mortality risk declined significantly among patients with renal failure (from 50.0 to 4.0 %) and heart failure (from 17.9 to 5.2 %; both P < 0.001) while changes in cases with ischemic heart disease, cancer, and liver failure were less significant.
UGIB morality risks, especially of the first hospital day and geriatric patients, significantly decreased over the last three decades, presumably from recent advances in emergency medical care. Mortality risk of gastric, but not duodenal, bleeding had the most significant reduction. Critical care improvements in patients with various comorbidities may explain significant UGIB mortality risk reductions. This study provides invaluable insight into the causes and trends of UGIB mortality risks for future studies.
上消化道出血（UGIB）每年导致的医疗费用超过 10 亿美元。
本研究旨在探讨过去三十年 UGIB 死亡率风险和趋势的变化。
我们分析了 1979 年至 2009 年的国家医院出院样本。纳入的患者具有代表 UGIB 诊断的主要 ICD-9 代码。分析了每个十年按解剖部位、出血原因、合并症和其他重要变量划分的 UGIB 死亡率风险和趋势。
UGIB 死亡率从第一个十年的 4.8%下降到第三个十年的 3.1%，下降了 35.4%（P<0.001）。年龄和住院天数是所有十年的重要危险因素。在所有十年中，年龄超过 65 岁和入院第一天的患者下降幅度最大。胃（P<0.001）和食管（P=0.018）出血的死亡率风险呈显著下降趋势。十二指肠出血的死亡率风险在三个十年中保持稳定。肾衰竭（从 50.0%降至 4.0%）和心力衰竭（从 17.9%降至 5.2%；均 P<0.001）患者的死亡率风险显著下降，而缺血性心脏病、癌症和肝功能衰竭患者的死亡率风险变化不显著。
在过去的三十年中，UGIB 的死亡率风险，尤其是在第一个住院日和老年患者中，显著降低，这可能是由于最近在急诊医疗方面的进步。胃出血（但不是十二指肠出血）的死亡率风险降幅最大。各种合并症患者的重症监护改善可能解释了 UGIB 死亡率风险的显著降低。本研究为未来研究提供了宝贵的见解，了解 UGIB 死亡率风险的原因和趋势。
