Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe

• Published in: Alimentary pharmacology & therapeutics 2011-06, Vol.33 (11), p.1225-1233
• Main Authors: Lanas, A., Aabakken, L., Fonseca, J., Mungan, Z. A., Papatheodoridis, G. V., Piessevaux, H., Cipolletta, L., Nuevo, J., Tafalla, M.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Endoscopy, Gastrointestinal - methods; Europe - epidemiology; Female; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - physiopathology; Gastrointestinal Hemorrhage - therapy; Humans; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2011.04651.x

Aliment Pharmacol Ther 2011; 33: 1225–1233 Summary Background  Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. Aim  To report outcomes and predictive factors for bleeding continuation/re‐bleeding and mortality of NVUGIB in clinical practice in different European countries. Methods  This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re‐bleeding, pharmacological treatment, surgery and mortality during 30‐days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. Results  Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re‐bleeding (range: 9–15.8%) or death (2.5–8%) at 30 days were explained by clinical factors (number of comorbidities, age > 65 years, history of bleeding ulcers, in‐hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high‐risk stigmata. Conclusion  Differences in the outcomes of nonvariceal upper gastrointestinal bleeding in clinical practice across some European countries are explained mainly by patient‐related factors, and not by management factors.