Independent predictors of in-hospital re-bleeding, need of operation and mortality in acute upper gastrointestinal bleeding.

Abstract

Prediction of outcome is difficult in patients with acute upper gastrointestinal bleeding (AUGIB). Some factors have been proposed in this regard with varying accuracy. This study aimed to investigate probable predictors of in-hospital outcome in patients with AUGIB. One hundred sixty four patients with AUGIB were studied prospectively in Tabriz Imam Reza Teaching Centre. All these patients were evaluated endoscopically by an expert. Patients' age, gender, presenting complains, transfusion, clinical findings and previous medical history were compared between survived vs. expired, re-bled vs. non re-bled and operated vs. non operated patients. There were 117 males and 47 females with the mean age of 57.12 +/- 17.32 (range: 32-78) years in this study. Hematemesis was the sole independent predictor of in-hospital mortality (82.1 vs. 100%; p < 0.001). In univariate analysis, however, female gender, major hemorrhage and previous neurological disease were associated with higher rate of expiration. Comparing two re-bled and non re-bled groups, hematemesis (76.5 vs. 95.9%; p = 0.003) and need of transfusion > 2U (36.1 vs. 71.4%; p = 0.006) were independent predictors of re-bleeding. In univariate analysis, hematocrit < 30%, major hemorrhage and previous history of hepatic disease or hypertension were predictive of re-bleeding. In comparison between operated and non operated groups no significant predictor was detected. In conclusion, this study showed that presence of hematemesis at the time of admission and need of transfusion > 2U were independent predictors of poor outcome in patients with AUGIB.