Department of Internal Medicine, Section of Gastroenterology and Hepatology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
Scand J Gastroenterol. 2021 Jan;56(1):1-5. doi: 10.1080/00365521.2020.1849384. Epub 2020 Nov 23.
Data on long-term rebleeding risk and mortality in acute upper gastrointestinal bleeding (AUGIB) patients are scarce and comparison to controls are lacking. Aimsof the study were to assess long-term prognosis of AUGIB patients and compare to controls.
A population-based retrospective case-control study conducted at the National University Hospital of Iceland and included all patients who underwent endoscopy in 2010-2011. AUGIB was defined as haematemesis or coffee ground vomiting leading to hospitalization or occurring in a hospitalized patient. Controls underwent endoscopy in 2010-2011, matched for sex/age. Rebleeding was defined as AUGIB >14 days up to five years after index bleeding.
Overall, 303 patients had AUGIB, mean age 67 (±18), controls66 years (±19), females, 51 and 46%, respectively. The five-year rebleeding rate for AUGIB patients was 13% (95%CI 9-17%), higher than the rate of bleeding events in controls, 3% (95%CI 1-5%; log-rank <0.001), hazard ratio (HR) 6.0 (95%CI 2.4-15) when correcting for comorbidities, NSAID's, PPI's and antithrombotics. The mortality of AUGIB patients at end of follow-up was higher when compared to controls, 39% (95%CI 49-33%) vs. 26% (95%CI 30-21%), log-rank <0.001, comorbidity-adjusted HR 1.4 (1.1-1.9). A subanalysis of non-variceal AUGIB yielded similar results in regard to rebleeding and mortality rates.
AUGIB patients were at 6-fold risk of rebleeding compared to bleeding events in controls at five years of follow-up. Five-year mortality was higher in AUGIB patients when compared to controls even when correcting for age and comorbidities, suggesting that an episode of AUGIB indicates serious frailty.
急性上消化道出血 (AUGIB) 患者的长期再出血风险和死亡率数据稀缺，且缺乏与对照者的比较。本研究旨在评估 AUGIB 患者的长期预后，并与对照者进行比较。
这是一项在冰岛国家大学医院进行的基于人群的回顾性病例对照研究，纳入了所有在 2010-2011 年接受内镜检查的患者。AUGIB 定义为呕血或咖啡渣样呕吐导致住院或住院患者发生。对照者在 2010-2011 年进行内镜检查，性别/年龄匹配。再出血定义为指数性出血后 14 天至 5 年内发生的 AUGIB。
总体而言，303 例患者患有 AUGIB，平均年龄 67（±18）岁，对照组为 66 岁（±19）岁，女性分别占 51%和 46%。AUGIB 患者的 5 年再出血率为 13%（95%CI 9-17%），高于对照组的出血事件发生率，3%（95%CI 1-5%；log-rank <0.001），在校正合并症、非甾体抗炎药、质子泵抑制剂和抗血栓药物后，风险比（HR）为 6.0（95%CI 2.4-15）。与对照组相比，AUGIB 患者在随访结束时的死亡率更高，为 39%（95%CI 49-33%）比 26%（95%CI 30-21%），log-rank <0.001，校正合并症的 HR 为 1.4（1.1-1.9）。非静脉曲张性 AUGIB 的亚分析结果显示，再出血和死亡率也类似。
与对照组的出血事件相比，AUGIB 患者在 5 年的随访中再出血的风险增加了 6 倍。与对照组相比，即使在校正年龄和合并症后，AUGIB 患者的 5 年死亡率也更高，这表明 AUGIB 发作表明严重的虚弱。
