埃及上埃及地区非静脉曲张性上消化道出血肝硬化患者的院内死亡率结局及预测因素

Outcomes and predictors of in-hospital mortality among cirrhotic patients with non-variceal upper gastrointestinal bleeding in upper Egypt.

作者信息

Morsy Khairy H, Ghaliony Mohamed A A, Mohammed Hamdy S

机构信息

Department of Tropical Medicine and Gastroenterology, Sohag University Faculty of Medicine, Sohag, Egypt.

出版信息

Turk J Gastroenterol. 2014 Dec;25(6):707-13. doi: 10.5152/tjg.2014.6710.

DOI:10.5152/tjg.2014.6710

PMID:25599786

Abstract

BACKGROUND/AIMS: Variceal bleeding is one of the most frequent causes of morbidity and mortality among cirrhotic patients. Clinical endoscopic features and outcomes of cirrhotic patients with non-variceal upper gastrointestinal bleeding (NVUGIB) have been rarely reported. Our aim is to identify treatment outcomes and predictors of in-hospital mortality among cirrhotic patients with non-variceal bleeding in Upper Egypt.

MATERIALS AND METHODS

A prospective study of 93 cirrhotic patients with NVUGIB who were admitted to the Tropical Medicine and Gastroenterology Department, Assiut University Hospital (Assiut, Egypt) over a one-year period (November 2011 to October 2012). Clinical features, endoscopic findings, clinical outcomes, and in-hospital mortality rates were studied. Patient mortality during hospital stay was reported. Many independent risk factors of mortality were evaluated by means of univariate and multiple logistic regression analyses.

RESULTS

Of 93 patients, 65.6% were male with a mean age of 53.3 years. The most frequent cause of bleeding was duodenal ulceration (26.9%). Endoscopic treatment was needed in 45.2% of patients, rebleeding occurred in 4.3%, and the in-hospital mortality was 14%. Hypovolemic shock was the most common cause of death (46.2%). Independent risk factors of in-hospital mortality among cirrhotic patients with NVUGIB in our study were bacterial infection during hospitalization [odds ratio (OR) =0.32, 95% confidence interval (CI) =0.03-0.89], shock (OR =1.12, 95% CI =0.68-1.54), early rebleeding (OR =2.26, 95% CI =1.85-3.21), low serum albumin (OR =3.81, 95% CI =2.35-4.67), low baseline hemoglobin (OR =0.714, 95% CI =0.32-1.24), and the need for endoscopic treatment (OR =2.96, 95% CI =0.62-3.63).

CONCLUSION

Bacterial infection during hospitalization, shock, early rebleeding, low serum albumin, low baseline hemoglobin, and the need for endoscopic treatment were independent risk factors of in-hospital mortality among cirrhotic patients with NVUGIB in Upper Egypt.

摘要

背景/目的：静脉曲张出血是肝硬化患者发病和死亡的最常见原因之一。关于非静脉曲张性上消化道出血（NVUGIB）肝硬化患者的临床内镜特征及预后鲜有报道。我们的目的是确定埃及上埃及地区非静脉曲张性出血肝硬化患者的治疗结局及院内死亡的预测因素。

材料与方法

对93例NVUGIB肝硬化患者进行前瞻性研究，这些患者于1年期间（2011年11月至2012年10月）入住阿斯尤特大学医院热带医学与胃肠病科（埃及阿斯尤特）。研究了临床特征、内镜检查结果、临床结局及院内死亡率。报告了患者住院期间的死亡率。通过单因素和多因素逻辑回归分析评估了许多死亡的独立危险因素。

结果

93例患者中，65.6%为男性，平均年龄53.3岁。最常见的出血原因是十二指肠溃疡（26.9%）。45.2%的患者需要内镜治疗，再出血发生率为4.3%，院内死亡率为14%。低血容量性休克是最常见的死亡原因（46.2%）。在我们的研究中，NVUGIB肝硬化患者院内死亡的独立危险因素为住院期间细菌感染[比值比（OR）=0.32，95%置信区间（CI）=0.03 - 0.89]、休克（OR =1.12，95% CI =0.68 - 1.54）、早期再出血（OR =2.26，95% CI =1.85 - 3.21）、低血清白蛋白（OR =3.81，95% CI =2.35 - 4.67）、低基线血红蛋白（OR =0.714，95% CI =0.32 - 1.24）以及需要内镜治疗（OR =2.96，95% CI =0.62 - 3.63）。