Miilunpohja S, Jyrkkä J, Kärkkäinen J M, Kastarinen H, Heikkinen M, Paajanen H, Rantanen T, Hartikainen Jek
a Heart Centre , Kuopio University Hospital , Kuopio , Finland.
b Department of Emergency , Kuopio University Hospital , Kuopio , Finland.
Scand J Gastroenterol. 2017 Nov;52(11):1211-1218. doi: 10.1080/00365521.2017.1347811. Epub 2017 Jul 12.
Upper gastrointestinal bleeding (UGIB) is a common emergency, with in-hospital mortality between 3 and 14%. However, the long-term mortality and causes of death are unknown. We investigated the long-term mortality and causes of death in UGIB patients in a retrospective single-centre case-control study design.
A total of 569 consecutive patients, aged ≥18 years, admitted to Kuopio University Hospital for their first endoscopically verified UGIB during the years 2009-2011 were identified from hospital records. For each UGIB patient, an age, sex and hospital district matched control patient was identified from the Statistics Finland database. Data on endoscopy procedures, laboratory values, comorbidities and medication were obtained from patient records. Data on deaths and causes of death were obtained from Statistics Finland.
In-hospital mortality of UGIB patients was low at 3.3%. The long-term (mean follow-up 32 months) mortality of UGIB patients was significantly higher than controls (34.1 versus 12.1%, p < .001). During the 6 months following UGIB, the risk of death compared to controls was highest (HR 19.2, 95% CI 7.0-52.4, p < .001) and remained higher up to 3 years after the bleeding. Beyond 3 years' follow-up, there was no difference in mortality between the groups (HR 0.7, 95% CI 0.4-1.6, p = .436). During the first 3 months after the UGIB episode, mortality was related to gastrointestinal diseases; after 3 months, the causes of death were related to comorbidities and did not differ from causes of death in controls.
UGIB patients have three times higher long-term mortality than population controls.
上消化道出血（UGIB）是一种常见的急症，住院死亡率在3%至14%之间。然而，长期死亡率和死亡原因尚不清楚。我们采用回顾性单中心病例对照研究设计，对UGIB患者的长期死亡率和死亡原因进行了调查。
从医院记录中识别出2009年至2011年期间因首次经内镜证实的UGIB入住库奥皮奥大学医院的569例年龄≥18岁的连续患者。对于每例UGIB患者，从芬兰统计局数据库中识别出年龄、性别和医院辖区匹配的对照患者。从患者记录中获取内镜检查程序、实验室值、合并症和用药的数据。从芬兰统计局获取死亡和死亡原因的数据。
UGIB患者的住院死亡率较低，为3.3%。UGIB患者的长期（平均随访32个月）死亡率显著高于对照组（34.1%对12.1%，p<0.001）。在UGIB后的6个月内，与对照组相比，死亡风险最高（HR 19.2，95%CI 7.0-52.4，p<0.001），并且在出血后长达3年仍较高。随访超过3年后，两组之间的死亡率没有差异（HR 0.7，95%CI 0.4-1.6，p=0.436）。在UGIB发作后的前3个月内，死亡率与胃肠道疾病有关；3个月后，死亡原因与合并症有关，与对照组的死亡原因没有差异。
UGIB患者的长期死亡率比总体对照组高3倍。
