Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort
Objectives 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. Methods We conducted a multicentr...
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| Veröffentlicht in: | United European Gastroenterology Journal 2021-07, Vol.9 (6), p.707-717 |
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| creator | Hajj, Weam Quentin, Vincent Boudoux D'Hautefeuille, Gaelle Vandamme, Helene Berger, Chantal Moussaoui, Mohammed Redha Berete, Aliou Louvel, Dominique Bertolino, Jean Guy Cuillerier, Emmanuel Thiebault, Quentin Arondel, Yves Grimbert, Sylvie Guillou, Brigitte Borel, Isabelle Lahmek, Pierre Nahon, Stéphane |
| description | Objectives
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.
Methods
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.
Results
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 |
| doi_str_mv | 10.1002/ueg2.12096 |
| format | Article |
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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.
Methods
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.
Results
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).
Conclusion
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.
Key Point
Summarize the established knowledge on this subject
Upper gastrointestinal bleeding (UGIB) in already hospitalised patients (IPs) appears to have a worse prognosis when compared to UGIB in out‐patients (OPs).
Few studies have addressed this issue, most of which are retrospective. They found a poor short‐term outcome in IPs without being able to identify modifiable risk factors that could affect the prognosis.
Significant and/or new findings of this study?
We demonstrated in this prospective and multicentre study a greater 6‐week mortality and rebleeding rates in IPs versus OPs.
IPs were older and had a higher rate of comorbidities. Prothrombin time <50% and rebleeding were independently associated with a higher mortality rate in IPs.
An appropriate bleeding management and an optimal rebleeding prevention plan might improve the outcome of UGIB in already hospitalised patients.]]></description><identifier>ISSN: 2050-6406</identifier><identifier>EISSN: 2050-6414</identifier><identifier>DOI: 10.1002/ueg2.12096</identifier><identifier>PMID: 34102016</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Alcohol ; Anticoagulants ; Blood ; Blood pressure ; Body mass index ; Comorbidity ; Comparative analysis ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices - complications ; Esophageal and Gastric Varices - diagnosis ; Female ; Females ; France ; France - epidemiology ; Gastrointestinal bleeding ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - mortality ; Health aspects ; Heart rate ; Hemodynamics ; Hemoglobin ; Hospitalization ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Hypertension ; in‐patients ; Liver cirrhosis ; Male ; Medical examination ; Middle Aged ; Mortality ; non‐variceal bleeding ; Original ; peptic ulcer disease ; portal hypertension ; Prognosis ; Prospective Studies ; Recurrence ; Regression Analysis ; Risk Assessment - methods ; Statistical analysis ; Thrombin ; upper GI bleeding ; upper GI endoscopy ; variceal bleeding</subject><ispartof>United European Gastroenterology Journal, 2021-07, Vol.9 (6), p.707-717</ispartof><rights>2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.</rights><rights>COPYRIGHT 2021 John Wiley & Sons, Inc.</rights><rights>2021. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5156-da1e3abe2918eaecc11bf5ca4a86f5a5fe8631583f316328fb932ded9bc86fcf3</citedby><cites>FETCH-LOGICAL-c5156-da1e3abe2918eaecc11bf5ca4a86f5a5fe8631583f316328fb932ded9bc86fcf3</cites><orcidid>0000-0002-6205-4157</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280797/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280797/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,11541,27901,27902,45550,45551,46027,46451,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34102016$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hajj, Weam</creatorcontrib><creatorcontrib>Quentin, Vincent</creatorcontrib><creatorcontrib>Boudoux D'Hautefeuille, Gaelle</creatorcontrib><creatorcontrib>Vandamme, Helene</creatorcontrib><creatorcontrib>Berger, Chantal</creatorcontrib><creatorcontrib>Moussaoui, Mohammed Redha</creatorcontrib><creatorcontrib>Berete, Aliou</creatorcontrib><creatorcontrib>Louvel, Dominique</creatorcontrib><creatorcontrib>Bertolino, Jean Guy</creatorcontrib><creatorcontrib>Cuillerier, Emmanuel</creatorcontrib><creatorcontrib>Thiebault, Quentin</creatorcontrib><creatorcontrib>Arondel, Yves</creatorcontrib><creatorcontrib>Grimbert, Sylvie</creatorcontrib><creatorcontrib>Guillou, Brigitte</creatorcontrib><creatorcontrib>Borel, Isabelle</creatorcontrib><creatorcontrib>Lahmek, Pierre</creatorcontrib><creatorcontrib>Nahon, Stéphane</creatorcontrib><creatorcontrib>ANGH for the SANGHRIA Study Group</creatorcontrib><title>Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort</title><title>United European Gastroenterology Journal</title><addtitle>United European Gastroenterol J</addtitle><description><![CDATA[Objectives
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.
Methods
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.
Results
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).
Conclusion
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.
Key Point
Summarize the established knowledge on this subject
Upper gastrointestinal bleeding (UGIB) in already hospitalised patients (IPs) appears to have a worse prognosis when compared to UGIB in out‐patients (OPs).
Few studies have addressed this issue, most of which are retrospective. They found a poor short‐term outcome in IPs without being able to identify modifiable risk factors that could affect the prognosis.
Significant and/or new findings of this study?
We demonstrated in this prospective and multicentre study a greater 6‐week mortality and rebleeding rates in IPs versus OPs.
IPs were older and had a higher rate of comorbidities. Prothrombin time <50% and rebleeding were independently associated with a higher mortality rate in IPs.
An appropriate bleeding management and an optimal rebleeding prevention plan might improve the outcome of UGIB in already hospitalised patients.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alcohol</subject><subject>Anticoagulants</subject><subject>Blood</subject><subject>Blood pressure</subject><subject>Body mass index</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Esophageal and Gastric Varices - complications</subject><subject>Esophageal and Gastric Varices - diagnosis</subject><subject>Female</subject><subject>Females</subject><subject>France</subject><subject>France - epidemiology</subject><subject>Gastrointestinal bleeding</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Health aspects</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Hemoglobin</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>in‐patients</subject><subject>Liver cirrhosis</subject><subject>Male</subject><subject>Medical examination</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>non‐variceal bleeding</subject><subject>Original</subject><subject>peptic ulcer disease</subject><subject>portal hypertension</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Regression Analysis</subject><subject>Risk Assessment - methods</subject><subject>Statistical analysis</subject><subject>Thrombin</subject><subject>upper GI bleeding</subject><subject>upper GI endoscopy</subject><subject>variceal bleeding</subject><issn>2050-6406</issn><issn>2050-6414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kt9qFDEUxgdRbFl74wNIwBsRds2fmdmMF0IpbRUKitjrcCZzMpuSTcZkZmXvfAShb9gnMXXqol6Yc5Fw8jtfTg5fUTxndMUo5W8m7PmKcdrUj4pjTiu6rEtWPj6caX1UnKR0Q_OSsuS8fFociZJRTll9XNx-iqH3IdlEgiE7iFYjOAK-Iz74u-8_DqlpGDCSHtIYg_UjptH6nG4dYmd9T6wn4CJCtyebkAY7grMJOzLAaNGP6S35jGlyYyImhi0BchHR6w0ZYqZRj3aHRIdNiOOz4okBl_DkYV8U1xfnX87eL68-Xn44O71a6opV9bIDhgJa5A2TCKg1Y62pNJQga1NBZVDWglVSGMFqwaVpG8E77JpWZ0AbsSjezbrD1G6x07nLCE4N0W4h7lUAq_6-8Xaj-rBTkku6btZZ4NWDQAxfpzwRtbVJo3PgMUxJ8Uo0FWeyZBl9-Q96E6aYB5iUoE0OynKTi2I1Uz04VNabkN_VOTrcWh08Gpvzp2uxZrxp6jIXvJ4LdJ5iimgO3TOq7v2h7v2hfvkjwy_-_O8B_e2GDLAZ-Jaf2f9HSl2fX_JZ9CfRhcp0</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Hajj, Weam</creator><creator>Quentin, Vincent</creator><creator>Boudoux D'Hautefeuille, Gaelle</creator><creator>Vandamme, Helene</creator><creator>Berger, Chantal</creator><creator>Moussaoui, Mohammed Redha</creator><creator>Berete, Aliou</creator><creator>Louvel, Dominique</creator><creator>Bertolino, Jean Guy</creator><creator>Cuillerier, Emmanuel</creator><creator>Thiebault, Quentin</creator><creator>Arondel, Yves</creator><creator>Grimbert, Sylvie</creator><creator>Guillou, Brigitte</creator><creator>Borel, Isabelle</creator><creator>Lahmek, Pierre</creator><creator>Nahon, Stéphane</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6205-4157</orcidid></search><sort><creationdate>202107</creationdate><title>Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort</title><author>Hajj, Weam ; Quentin, Vincent ; Boudoux D'Hautefeuille, Gaelle ; Vandamme, Helene ; Berger, Chantal ; Moussaoui, Mohammed Redha ; Berete, Aliou ; Louvel, Dominique ; Bertolino, Jean Guy ; Cuillerier, Emmanuel ; Thiebault, Quentin ; Arondel, Yves ; Grimbert, Sylvie ; Guillou, Brigitte ; Borel, Isabelle ; Lahmek, Pierre ; Nahon, Stéphane</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5156-da1e3abe2918eaecc11bf5ca4a86f5a5fe8631583f316328fb932ded9bc86fcf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alcohol</topic><topic>Anticoagulants</topic><topic>Blood</topic><topic>Blood pressure</topic><topic>Body mass index</topic><topic>Comorbidity</topic><topic>Comparative analysis</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Esophageal and Gastric Varices - complications</topic><topic>Esophageal and Gastric Varices - diagnosis</topic><topic>Female</topic><topic>Females</topic><topic>France</topic><topic>France - epidemiology</topic><topic>Gastrointestinal bleeding</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Health aspects</topic><topic>Heart rate</topic><topic>Hemodynamics</topic><topic>Hemoglobin</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>in‐patients</topic><topic>Liver cirrhosis</topic><topic>Male</topic><topic>Medical examination</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>non‐variceal bleeding</topic><topic>Original</topic><topic>peptic ulcer disease</topic><topic>portal hypertension</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Regression Analysis</topic><topic>Risk Assessment - methods</topic><topic>Statistical analysis</topic><topic>Thrombin</topic><topic>upper GI bleeding</topic><topic>upper GI endoscopy</topic><topic>variceal bleeding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hajj, Weam</creatorcontrib><creatorcontrib>Quentin, Vincent</creatorcontrib><creatorcontrib>Boudoux D'Hautefeuille, Gaelle</creatorcontrib><creatorcontrib>Vandamme, Helene</creatorcontrib><creatorcontrib>Berger, Chantal</creatorcontrib><creatorcontrib>Moussaoui, Mohammed Redha</creatorcontrib><creatorcontrib>Berete, Aliou</creatorcontrib><creatorcontrib>Louvel, Dominique</creatorcontrib><creatorcontrib>Bertolino, Jean Guy</creatorcontrib><creatorcontrib>Cuillerier, Emmanuel</creatorcontrib><creatorcontrib>Thiebault, Quentin</creatorcontrib><creatorcontrib>Arondel, Yves</creatorcontrib><creatorcontrib>Grimbert, Sylvie</creatorcontrib><creatorcontrib>Guillou, Brigitte</creatorcontrib><creatorcontrib>Borel, Isabelle</creatorcontrib><creatorcontrib>Lahmek, Pierre</creatorcontrib><creatorcontrib>Nahon, Stéphane</creatorcontrib><creatorcontrib>ANGH for the SANGHRIA Study Group</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>United European Gastroenterology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hajj, Weam</au><au>Quentin, Vincent</au><au>Boudoux D'Hautefeuille, Gaelle</au><au>Vandamme, Helene</au><au>Berger, Chantal</au><au>Moussaoui, Mohammed Redha</au><au>Berete, Aliou</au><au>Louvel, Dominique</au><au>Bertolino, Jean Guy</au><au>Cuillerier, Emmanuel</au><au>Thiebault, Quentin</au><au>Arondel, Yves</au><au>Grimbert, Sylvie</au><au>Guillou, Brigitte</au><au>Borel, Isabelle</au><au>Lahmek, Pierre</au><au>Nahon, Stéphane</au><aucorp>ANGH for the SANGHRIA Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort</atitle><jtitle>United European Gastroenterology Journal</jtitle><addtitle>United European Gastroenterol J</addtitle><date>2021-07</date><risdate>2021</risdate><volume>9</volume><issue>6</issue><spage>707</spage><epage>717</epage><pages>707-717</pages><issn>2050-6406</issn><eissn>2050-6414</eissn><abstract><![CDATA[Objectives
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.
Methods
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.
Results
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).
Conclusion
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.
Key Point
Summarize the established knowledge on this subject
Upper gastrointestinal bleeding (UGIB) in already hospitalised patients (IPs) appears to have a worse prognosis when compared to UGIB in out‐patients (OPs).
Few studies have addressed this issue, most of which are retrospective. They found a poor short‐term outcome in IPs without being able to identify modifiable risk factors that could affect the prognosis.
Significant and/or new findings of this study?
We demonstrated in this prospective and multicentre study a greater 6‐week mortality and rebleeding rates in IPs versus OPs.
IPs were older and had a higher rate of comorbidities. Prothrombin time <50% and rebleeding were independently associated with a higher mortality rate in IPs.
An appropriate bleeding management and an optimal rebleeding prevention plan might improve the outcome of UGIB in already hospitalised patients.]]></abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>34102016</pmid><doi>10.1002/ueg2.12096</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6205-4157</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2050-6406 |
| ispartof | United European Gastroenterology Journal, 2021-07, Vol.9 (6), p.707-717 |
| issn | 2050-6406 2050-6414 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8280797 |
| source | MEDLINE; Wiley Online Library Open Access; Wiley Online Library Journals Frontfile Complete; PubMed Central |
| subjects | Aged Aged, 80 and over Alcohol Anticoagulants Blood Blood pressure Body mass index Comorbidity Comparative analysis Endoscopy Endoscopy, Gastrointestinal Esophageal and Gastric Varices - complications Esophageal and Gastric Varices - diagnosis Female Females France France - epidemiology Gastrointestinal bleeding Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Health aspects Heart rate Hemodynamics Hemoglobin Hospitalization Hospitalization - statistics & numerical data Hospitals Humans Hypertension in‐patients Liver cirrhosis Male Medical examination Middle Aged Mortality non‐variceal bleeding Original peptic ulcer disease portal hypertension Prognosis Prospective Studies Recurrence Regression Analysis Risk Assessment - methods Statistical analysis Thrombin upper GI bleeding upper GI endoscopy variceal bleeding |
| title | Prognosis of variceal and non‐variceal upper gastrointestinal bleeding in already hospitalised patients: Results from a French prospective cohort |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T23%3A37%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prognosis%20of%20variceal%20and%20non%E2%80%90variceal%20upper%20gastrointestinal%20bleeding%20in%20already%20hospitalised%20patients:%20Results%20from%20a%20French%20prospective%20cohort&rft.jtitle=United%20European%20Gastroenterology%20Journal&rft.au=Hajj,%20Weam&rft.aucorp=ANGH%20for%20the%20SANGHRIA%20Study%20Group&rft.date=2021-07&rft.volume=9&rft.issue=6&rft.spage=707&rft.epage=717&rft.pages=707-717&rft.issn=2050-6406&rft.eissn=2050-6414&rft_id=info:doi/10.1002/ueg2.12096&rft_dat=%3Cgale_pubme%3EA737129964%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3090900116&rft_id=info:pmid/34102016&rft_galeid=A737129964&rfr_iscdi=true |