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Article: Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy
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TitlePredicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy
 
AuthorsChiu, PWY1
Ng, EKW1
Cheung, FKY1
Chan, FKL1
Leung, WK1
Wu, JCY1
Wong, VWS1
Yung, MY1
Tsoi, K1
Lau, JYW1
Sung, JJY1
Chung, SSC1
 
Issue Date2009
 
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/cgh
 
CitationClinical Gastroenterology And Hepatology, 2009, v. 7 n. 3, p. 311-316 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.cgh.2008.08.044
 
AbstractBackground & Aims: Despite advances in management of patients with bleeding peptic ulcers, mortality is still 10%. This study aimed to identify predictive factors and to develop a prediction model for mortality among patients with bleeding peptic ulcers. Methods: Consecutive patients with endoscopic stigmata of active bleeding, visible vessels, or adherent clots were recruited, and risk factors for mortality were identified in this deprivation cohort by using multiple stepwise logistic regression. A prediction model was then built on the basis of these factors and validated in the evaluation cohort. Results: From 1993 to 2003, 3220 patients with bleeding peptic ulcers were treated. Two hundred eighty-four of the patients developed rebleeding (8.8%); emergency surgery was performed on 47 of these patients, whereas others were managed with endoscopic retreatment. Two hundred twenty-nine of these sustained in-hospital death (7.1%). In patients older than 70 years, presence of comorbidity, more than 1 listed comorbidity, hematemesis on presentation, systolic blood pressure below 100 mm Hg, in-hospital bleeding, rebleeding, and need for surgery were significant predictors for mortality. Helicobacter pylori-related ulcers had lower risk of mortality. The receiver operating characteristic curve comparing the prediction of mortality with actual mortality showed an area under the curve of 0.842. From 2004 to 2006, data were collected prospectively from a second cohort of patients with bleeding peptic ulcers, and mortality was predicted by using the model developed. The receiver operating characteristic curve showed an area under the curve of 0.729. Conclusions: Among patients with bleeding peptic ulcers after endoscopic hemostasis, advanced age, presence of listed comorbidity, multiple comorbidities, hypovolemic shock, in-hospital bleeding, rebleeding, and need for surgery successfully predicted in-hospital mortality. © 2009 AGA Institute.
 
ISSN1542-3565
2013 Impact Factor: 6.534
 
DOIhttp://dx.doi.org/10.1016/j.cgh.2008.08.044
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorChiu, PWY
 
dc.contributor.authorNg, EKW
 
dc.contributor.authorCheung, FKY
 
dc.contributor.authorChan, FKL
 
dc.contributor.authorLeung, WK
 
dc.contributor.authorWu, JCY
 
dc.contributor.authorWong, VWS
 
dc.contributor.authorYung, MY
 
dc.contributor.authorTsoi, K
 
dc.contributor.authorLau, JYW
 
dc.contributor.authorSung, JJY
 
dc.contributor.authorChung, SSC
 
dc.date.accessioned2012-09-05T05:29:00Z
 
dc.date.available2012-09-05T05:29:00Z
 
dc.date.issued2009
 
dc.description.abstractBackground & Aims: Despite advances in management of patients with bleeding peptic ulcers, mortality is still 10%. This study aimed to identify predictive factors and to develop a prediction model for mortality among patients with bleeding peptic ulcers. Methods: Consecutive patients with endoscopic stigmata of active bleeding, visible vessels, or adherent clots were recruited, and risk factors for mortality were identified in this deprivation cohort by using multiple stepwise logistic regression. A prediction model was then built on the basis of these factors and validated in the evaluation cohort. Results: From 1993 to 2003, 3220 patients with bleeding peptic ulcers were treated. Two hundred eighty-four of the patients developed rebleeding (8.8%); emergency surgery was performed on 47 of these patients, whereas others were managed with endoscopic retreatment. Two hundred twenty-nine of these sustained in-hospital death (7.1%). In patients older than 70 years, presence of comorbidity, more than 1 listed comorbidity, hematemesis on presentation, systolic blood pressure below 100 mm Hg, in-hospital bleeding, rebleeding, and need for surgery were significant predictors for mortality. Helicobacter pylori-related ulcers had lower risk of mortality. The receiver operating characteristic curve comparing the prediction of mortality with actual mortality showed an area under the curve of 0.842. From 2004 to 2006, data were collected prospectively from a second cohort of patients with bleeding peptic ulcers, and mortality was predicted by using the model developed. The receiver operating characteristic curve showed an area under the curve of 0.729. Conclusions: Among patients with bleeding peptic ulcers after endoscopic hemostasis, advanced age, presence of listed comorbidity, multiple comorbidities, hypovolemic shock, in-hospital bleeding, rebleeding, and need for surgery successfully predicted in-hospital mortality. © 2009 AGA Institute.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationClinical Gastroenterology And Hepatology, 2009, v. 7 n. 3, p. 311-316 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.cgh.2008.08.044
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.cgh.2008.08.044
 
dc.identifier.epage316
 
dc.identifier.issn1542-3565
2013 Impact Factor: 6.534
 
dc.identifier.issue3
 
dc.identifier.pmid18955161
 
dc.identifier.scopuseid_2-s2.0-60949084361
 
dc.identifier.spage311
 
dc.identifier.urihttp://hdl.handle.net/10722/163232
 
dc.identifier.volume7
 
dc.languageeng
 
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/cgh
 
dc.publisher.placeUnited States
 
dc.relation.ispartofClinical Gastroenterology and Hepatology
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAged
 
dc.subject.meshAged, 80 And Over
 
dc.subject.meshEndoscopy
 
dc.subject.meshFemale
 
dc.subject.meshHelicobacter Infections - Complications
 
dc.subject.meshHospital Mortality
 
dc.subject.meshHumans
 
dc.subject.meshMale
 
dc.subject.meshPeptic Ulcer - Complications
 
dc.subject.meshPeptic Ulcer Hemorrhage - Mortality - Surgery
 
dc.subject.meshRisk Factors
 
dc.subject.meshTreatment Outcome
 
dc.titlePredicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy
 
dc.typeArticle
 
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<contributor.author>Leung, WK</contributor.author>
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<contributor.author>Wong, VWS</contributor.author>
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<description.abstract>Background &amp; Aims: Despite advances in management of patients with bleeding peptic ulcers, mortality is still 10%. This study aimed to identify predictive factors and to develop a prediction model for mortality among patients with bleeding peptic ulcers. Methods: Consecutive patients with endoscopic stigmata of active bleeding, visible vessels, or adherent clots were recruited, and risk factors for mortality were identified in this deprivation cohort by using multiple stepwise logistic regression. A prediction model was then built on the basis of these factors and validated in the evaluation cohort. Results: From 1993 to 2003, 3220 patients with bleeding peptic ulcers were treated. Two hundred eighty-four of the patients developed rebleeding (8.8%); emergency surgery was performed on 47 of these patients, whereas others were managed with endoscopic retreatment. Two hundred twenty-nine of these sustained in-hospital death (7.1%). In patients older than 70 years, presence of comorbidity, more than 1 listed comorbidity, hematemesis on presentation, systolic blood pressure below 100 mm Hg, in-hospital bleeding, rebleeding, and need for surgery were significant predictors for mortality. Helicobacter pylori-related ulcers had lower risk of mortality. The receiver operating characteristic curve comparing the prediction of mortality with actual mortality showed an area under the curve of 0.842. From 2004 to 2006, data were collected prospectively from a second cohort of patients with bleeding peptic ulcers, and mortality was predicted by using the model developed. The receiver operating characteristic curve showed an area under the curve of 0.729. Conclusions: Among patients with bleeding peptic ulcers after endoscopic hemostasis, advanced age, presence of listed comorbidity, multiple comorbidities, hypovolemic shock, in-hospital bleeding, rebleeding, and need for surgery successfully predicted in-hospital mortality. &#169; 2009 AGA Institute.</description.abstract>
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Author Affiliations
  1. Prince of Wales Hospital Hong Kong