Department of Gastroenterology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Endoscopy. 2021 Dec;53(12):1210-1218. doi: 10.1055/a-1330-7118. Epub 2021 Feb 18.
Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported.
This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality.
242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 - 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 - 0.80; < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 - 0.87; < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 - 3.04; < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 - 6.94; < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 - 2.18; < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 - 1.23; < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 - 1353.8] per 100 000 men in 2003).
Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.
上消化道出血（UGIB）是一种常见的医学急症，死亡率很高。尽管内镜和临床管理方面取得了进展，但报告的结果仅略有改善。
这是一项在英格兰于 2003 年至 2015 年间对非恶性 UGIB 急诊入院患者进行的回顾性队列研究，使用了医院病例统计数据。多水平逻辑回归分析检查了与死亡率相关的因素。
共确定了 242796 名 UGIB 入院患者（58.8%为男性；中位年龄 70 岁[四分位间距 53-81]）。2003 年至 2015 年间，30 天死亡率（7.5%降至 7.0%； ＜0.001）和年龄标准化死亡率（比值比（OR）0.74，95%置信区间[CI]0.69-0.80； ＜0.001）均有所下降，包括静脉曲张出血（OR 0.63，95%CI 0.45-0.87； ＜0.005）。合并症增多（Charlson 评分＞5，OR 2.94，95%CI 2.85-3.04； ＜0.001）、年龄较大（＞83 岁，OR 6.50，95%CI 6.09-6.94； ＜0.001）、静脉曲张出血（OR 2.03，95%CI 1.89-2.18； ＜0.001）和周末入院（周日，OR 1.18，95%CI 1.12-1.23； ＜0.001）与 30 天死亡率相关。30 天内死亡的患者中，有 8.9%死于缺血性心脏病（IHD），UGIB 后心血管年龄标准化死亡率很高（2003 年每 100000 名男性中有 1188.4[95%CI 1036.8-1353.8]人在一年内死于 IHD）。
2003 年至 2015 年间，非恶性 UGIB 急诊入院患者的 30 天死亡率下降了 0.5%至 7.0%。周末 UGIB 入院患者的死亡率更高，这对服务提供有重要影响。UGIB 患者随后死于心血管疾病的风险更高，因此，处理这种风险是 UGIB 管理的关键步骤。
