González-González José A, Monreal-Robles Roberto, García-Compean Diego, Paz-Delgadillo Jonathan, Wah-Suárez Martín, Maldonado-Garza Héctor J
Department of Gastroenterology, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
Department of Internal Medicine, Dr. José E. González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico.
J Dig Dis. 2017 Apr;18(4):212-221. doi: 10.1111/1751-2980.12459.
To analyze the clinical characteristics, outcomes and prognostic factors in elderly patients (aged 75 years and elder) with acute nonvariceal upper gastrointestinal bleeding (UGIB).
Consecutive patients admitted with acute nonvariceal UGIB who underwent upper gastrointestinal endoscopy were prospectively recruited and subdivided into two age-based groups, elderly (aged ≥75 years) and younger patients (<75 years). The patients' characteristics and outcomes were recorded.
Altogether 1136 patients were included in the study, 276 (24.3%) aged ≥75 years. Peptic ulcers, gastroduodenal erosions and esophagitis represented the three most common endoscopic lesions found in 87.7% of the elderly patients compared with 80.8% in younger patients ( P = 0.008). Overall, the rebleeding rate (4.0% vs 3.3%, P = 0.568), need for blood transfusion (66.3% vs 61.0%, P = 0.122), surgery rate (1.2% vs 1.4%, P = 0.947) and in-hospital mortality (13.0% vs 10.0%, P = 0.157) were not different between the two groups. In elderly patients, serum albumin was the only predictive variable independently associated with mortality in the overall analysis (OR 5.867, 95% CI 2.206-15.604, P < 0.001) and in the subgroup patients with peptic ulcers (OR 5.230, 95% CI 2.099-13.029, P = 0.001). Elderly patients with serum albumin >23.5 g/L at admission presented a low mortality (negative predictive value 97.3%).
Clinical evolution and mortality do not differ between the elderly and younger patients with acute nonvariceal UGIB. Serum albumin level at admission is a prognostic marker for mortality in elder patients.
分析老年患者（年龄≥75岁）急性非静脉曲张性上消化道出血（UGIB）的临床特征、转归及预后因素。
前瞻性纳入因急性非静脉曲张性UGIB入院并接受上消化道内镜检查的连续患者，将其按年龄分为两组，老年组（年龄≥75岁）和较年轻患者组（<75岁）。记录患者的特征及转归。
本研究共纳入1136例患者，其中276例（24.3%）年龄≥75岁。消化性溃疡、胃十二指肠糜烂和食管炎是最常见的三种内镜下病变，在87.7%的老年患者中出现，而较年轻患者中的比例为80.8%（P = 0.008）。总体而言，两组间再出血率（4.0% 对3.3%，P = 0.568）、输血需求（66.3% 对61.0%，P = 0.122）、手术率（1.2% 对1.4%，P = 0.947）及住院死亡率（13.0% 对10.0%，P = 0.157）无差异。在老年患者中，血清白蛋白是总体分析中唯一与死亡率独立相关的预测变量（OR 5.867，95% CI 2.206 - 15.604，P < 0.001），在消化性溃疡亚组患者中也是如此（OR 5.230，95% CI 2.099 - 13.029，P = 0.001）。入院时血清白蛋白>23.5 g/L的老年患者死亡率较低（阴性预测值97.3%）。
急性非静脉曲张性UGIB的老年患者与较年轻患者的临床病程及死亡率无差异。入院时血清白蛋白水平是老年患者死亡率的预后标志物。
