Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy

published online 16 September 2008.

Refers to article:

Exam 2: The Prediction of Mortality in Bleeding Peptic Ulcers After Therapeutic Endoscopy–Lessons Learned From 3000 Patients , 09 February 2009
Charles O. Elson
Clinical Gastroenterology and Hepatology
March 2009 (Vol. 7, Issue 3, Page 253)
Full-Text PDF (83 KB)

Do Predictors of Mortality in Upper Gastrointestinal Bleeding Include A Weekend Time of Admission? , 22 December 2008
Alan N. Barkun
Clinical Gastroenterology and Hepatology
March 2009 (Vol. 7, Issue 3, Pages 257-258)
Full Text | Full-Text PDF (141 KB)

Background & Aims

Despite advances in management of patients with bleeding peptic ulcers, mortality is still 10%. This study aimed to identify predictive factors and to develop a prediction model for mortality among patients with bleeding peptic ulcers.

Methods

Consecutive patients with endoscopic stigmata of active bleeding, visible vessels, or adherent clots were recruited, and risk factors for mortality were identified in this deprivation cohort by using multiple stepwise logistic regression. A prediction model was then built on the basis of these factors and validated in the evaluation cohort.

Results

From 1993 to 2003, 3220 patients with bleeding peptic ulcers were treated. Two hundred eighty-four of the patients developed rebleeding (8.8%); emergency surgery was performed on 47 of these patients, whereas others were managed with endoscopic retreatment. Two hundred twenty-nine of these sustained in-hospital death (7.1%). In patients older than 70 years, presence of comorbidity, more than 1 listed comorbidity, hematemesis on presentation, systolic blood pressure below 100 mm Hg, in-hospital bleeding, rebleeding, and need for surgery were significant predictors for mortality. Helicobacter pylori–related ulcers had lower risk of mortality. The receiver operating characteristic curve comparing the prediction of mortality with actual mortality showed an area under the curve of 0.842. From 2004 to 2006, data were collected prospectively from a second cohort of patients with bleeding peptic ulcers, and mortality was predicted by using the model developed. The receiver operating characteristic curve showed an area under the curve of 0.729.

Conclusions

Among patients with bleeding peptic ulcers after endoscopic hemostasis, advanced age, presence of listed comorbidity, multiple comorbidities, hypovolemic shock, in-hospital bleeding, rebleeding, and need for surgery successfully predicted in-hospital mortality.

Abbreviations used in this paper: AUC, area under the curve, ROC, receiver operating characteristic

⁎ Department of Surgery, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong

‡ Department of Medicine and Therapeutics, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong

Reprint requests Address requests for reprints to: Philip W. Y. Chiu, Department of Surgery, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong. fax: (852)-26377974

This article has an accompanying continuing medical education activity on page 253. Learning Objective—Identify factors associated with mortality in patients with bleeding peptic ulcer treated with therapeutic endoscopy.

Conflicts of interest The authors disclose the following: James Lau received consulting fees and lecture fees from AstraZeneca. Francis Chan received consultation fees from Pfizer, lecture fees from Takeda, Pfizer, and AstraZeneca, and grant support from Pfizer. Joseph Sung received lecture fees from AstraZeneca and GlaxoSmithKline.

PII: S1542-3565(08)00937-3

doi:10.1016/j.cgh.2008.08.044

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