Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
Centre Hospitalier de Saint Brieuc, Saint Brieuc, France.
United European Gastroenterol J. 2021 Jul;9(6):707-717. doi: 10.1002/ueg2.12096. Epub 2021 Jun 8.
Patients who develop upper gastrointestinal bleeding (UGIB) while in hospital appear to have a poor prognosis. Our study aims at analysing the difference in outcome between in-patients (IPs) and out-patients presenting with variceal and non-variceal UGIB.
We conducted a multicentre prospective study by collecting data about variceal and non-variceal UGIB cases through 46 hospitals in France between November 2017 and October 2018. We then compared baseline demographic features, endoscopic findings and outcome between patients who developed variceal and non-variceal UGIB on admission (OPs) and those at least 24 h after hospitalisation (IPs). Our primary end-point was mortality and re-bleeding rates at 6 weeks of bleeding onset.
A total of 2498 UGIB cases were identified, of whom 634 (25.4%) occurred in IPs. IPs were older than OPs (72.5 vs. 67.2 years old, p < 0.001) and had a higher rate of comorbidities (38.9% vs. 26.6%, p < 0.0001). Their bleeding was more severe with a Rockall score of >5 present in 40.9% (vs. 30.3% in OPs, p < 0.0001). The 6-week mortality rate was significantly higher in IPs when compared to OPs (21.7% vs. 8%, p < 0.0001). Prothrombin time <50% and rebleeding were the only independent predictors of mortality (p = 0.001 and 0.003, respectively). Six-week rebleeding occurred more frequently among IPs (18.6% vs. 14.4%, p = 0.015) and predictors included female sex, active bleeding upon endoscopy and a Blatchford score >11 (p = 0.017, 0.011 and 0.008, respectively).
IPs who develop variceal and non-variceal UGIB are more likely to be elderly with more comorbidities. They have a higher rate of mortality and rebleeding. Independent predictors of mortality were underlying coagulopathy and bleeding recurrence. An optimal bleeding management and efficient rebleeding prevention may improve outcome in these patients.
住院期间发生上消化道出血（UGIB）的患者预后似乎较差。本研究旨在分析因静脉曲张和非静脉曲张性 UGIB 入院的住院患者（IPs）和门诊患者（OPs）之间的结局差异。
我们通过法国 46 家医院在 2017 年 11 月至 2018 年 10 月期间收集静脉曲张性和非静脉曲张性 UGIB 病例的数据，开展了一项多中心前瞻性研究。然后，我们比较了入院时（OPs）和入院至少 24 小时后（IPs）发生静脉曲张性和非静脉曲张性 UGIB 的患者的基线人口统计学特征、内镜检查结果和结局。我们的主要终点是出血发作后 6 周的死亡率和再出血率。
共确定了 2498 例 UGIB 病例，其中 634 例（25.4%）为 IPs。与 OPs 相比，IPs 年龄更大（72.5 岁 vs. 67.2 岁，p<0.001），合并症发生率更高（38.9% vs. 26.6%，p<0.0001）。他们的出血更严重，Rockall 评分>5 的比例为 40.9%（OPs 为 30.3%，p<0.0001）。与 OPs 相比，IPs 的 6 周死亡率明显更高（21.7% vs. 8%，p<0.0001）。凝血酶原时间<50%和再出血是死亡率的唯一独立预测因素（p=0.001 和 0.003）。IPs 中 6 周再出血更常见（18.6% vs. 14.4%，p=0.015），女性、内镜检查时活动性出血和 Blatchford 评分>11 是再出血的预测因素（p=0.017、0.011 和 0.008）。
因静脉曲张和非静脉曲张性 UGIB 入院的 IPs 更有可能是年龄较大且合并症更多的患者。他们的死亡率和再出血率更高。潜在的凝血障碍和出血复发是死亡率的独立预测因素。对这些患者进行优化的出血管理和有效的再出血预防可能会改善结局。
