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Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study.
BMC Gastroenterol. 2017 Dec 20; 17(1):165.BG

Abstract

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in these patients.

METHODS

This was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate analysis, respectively.

RESULTS

A total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%) CONCLUSIONS: Oesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more aggressive management.

Authors+Show Affiliations

Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. sibumole@hotmail.com.Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29262794

Citation

Moledina, Sibtain M., and Ewaldo Komba. "Risk Factors for Mortality Among Patients Admitted With Upper Gastrointestinal Bleeding at a Tertiary Hospital: a Prospective Cohort Study." BMC Gastroenterology, vol. 17, no. 1, 2017, p. 165.
Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol. 2017;17(1):165.
Moledina, S. M., & Komba, E. (2017). Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterology, 17(1), 165. https://doi.org/10.1186/s12876-017-0712-8
Moledina SM, Komba E. Risk Factors for Mortality Among Patients Admitted With Upper Gastrointestinal Bleeding at a Tertiary Hospital: a Prospective Cohort Study. BMC Gastroenterol. 2017 Dec 20;17(1):165. PubMed PMID: 29262794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. AU - Moledina,Sibtain M, AU - Komba,Ewaldo, Y1 - 2017/12/20/ PY - 2017/02/20/received PY - 2017/11/27/accepted PY - 2017/12/22/entrez PY - 2017/12/22/pubmed PY - 2018/6/30/medline KW - Upper gastrointestinal bleeding mortality Tanzania SP - 165 EP - 165 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 17 IS - 1 N2 - BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in these patients. METHODS: This was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate analysis, respectively. RESULTS: A total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%) CONCLUSIONS: Oesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more aggressive management. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/29262794/Risk_factors_for_mortality_among_patients_admitted_with_upper_gastrointestinal_bleeding_at_a_tertiary_hospital:_a_prospective_cohort_study_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-017-0712-8 DB - PRIME DP - Unbound Medicine ER -