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Digestive Diseases and Sciences

, Volume 55, Issue 9, pp 2577–2583 | Cite as

Predictors of Rebleeding and Mortality in Patients with High-Risk Bleeding Peptic Ulcers

  • Chi-Liang Cheng
  • Cheng-Hui Lin
  • Chia-Jung Kuo
  • Kai-Feng Sung
  • Ching-Song Lee
  • Nai-Jen Liu
  • Jui-Hsiang Tang
  • Hao-Tsai Cheng
  • Yin-Yi Chu
  • Yung-Kuan Tsou
Original Article

Abstract

Background and Aim

Patients with bleeding ulcers can have recurrent bleeding and mortality after endoscopic therapy. Risk stratification is important in the management of the initial patient triage. The aim of this study is to identify the clinical and laboratory risk factors for recurrent bleeding and mortality.

Methods

A prospective study was conducted in 390 consecutive patients with bleeding peptic ulcers and high-risk endoscopic stigmata, e.g., active bleeding, a non-bleeding visible vessel, adherent blood clot, and hemorrhagic dot. We tested 13 available variables for association with recurrent bleeding and 15 were tested for association with mortality. A logistic regression model was used to identify individual correlates associated with these adverse outcomes.

Results

Bleeding recurred in 46 patients (11.8%) within 3 days and 21 patients (5.4%) had in-hospital mortality. In the full-factor analysis model, the incidence of recurrent bleeding was significantly higher in five of the 13 investigated variables and mortality was significantly higher in two of the 15 variables. In the final analysis model, significant risk factors for recurrent bleeding within 3 days, with adjusted odds ratios (OR), were in-hospital bleeding (OR 3.3), initial hemoglobin level <10 g/dl (OR 3.3) and ulcer ≥2 cm (OR 2.0). In-hospital bleeding was the only independent risk factor for mortality (OR 8.3).

Conclusion

The study emphasizes the role of ulcer size, anemia and in-hospital bleeding as the determining high-risk predictors for adverse outcomes for bleeding peptic ulcers.

Keywords

Risk factors Logic regression model Ulcer bleeding In-hospital bleeder 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Chi-Liang Cheng
    • 1
    • 2
  • Cheng-Hui Lin
    • 1
  • Chia-Jung Kuo
    • 1
  • Kai-Feng Sung
    • 1
  • Ching-Song Lee
    • 1
  • Nai-Jen Liu
    • 1
    • 2
  • Jui-Hsiang Tang
    • 1
  • Hao-Tsai Cheng
    • 1
  • Yin-Yi Chu
    • 1
  • Yung-Kuan Tsou
    • 1
  1. 1.Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalChang Gung UniversityQueishan, Taoyuan CountyTaiwan, ROC
  2. 2.Department of Medicine, Chang Gung Memorial HospitalChang Gung UniversityQueishan, Taoyuan CountyTaiwan, ROC

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