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Article: Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy

TitlePredicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy
Authors
Issue Date2009
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/cgh
Citation
Clinical Gastroenterology And Hepatology, 2009, v. 7 n. 3, p. 311-316 How to Cite?
Abstract
Background & 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.
Persistent Identifierhttp://hdl.handle.net/10722/163232
ISSN
2013 Impact Factor: 6.534
ISI Accession Number ID
References

 

Author Affiliations
  1. Prince of Wales Hospital Hong Kong
DC FieldValueLanguage
dc.contributor.authorChiu, PWYen_US
dc.contributor.authorNg, EKWen_US
dc.contributor.authorCheung, FKYen_US
dc.contributor.authorChan, FKLen_US
dc.contributor.authorLeung, WKen_US
dc.contributor.authorWu, JCYen_US
dc.contributor.authorWong, VWSen_US
dc.contributor.authorYung, MYen_US
dc.contributor.authorTsoi, Ken_US
dc.contributor.authorLau, JYWen_US
dc.contributor.authorSung, JJYen_US
dc.contributor.authorChung, SSCen_US
dc.date.accessioned2012-09-05T05:29:00Z-
dc.date.available2012-09-05T05:29:00Z-
dc.date.issued2009en_US
dc.identifier.citationClinical Gastroenterology And Hepatology, 2009, v. 7 n. 3, p. 311-316en_US
dc.identifier.issn1542-3565en_US
dc.identifier.urihttp://hdl.handle.net/10722/163232-
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.en_US
dc.languageengen_US
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/cghen_US
dc.relation.ispartofClinical Gastroenterology and Hepatologyen_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshEndoscopyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHelicobacter Infections - Complicationsen_US
dc.subject.meshHospital Mortalityen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshPeptic Ulcer - Complicationsen_US
dc.subject.meshPeptic Ulcer Hemorrhage - Mortality - Surgeryen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshTreatment Outcomeen_US
dc.titlePredicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopyen_US
dc.typeArticleen_US
dc.identifier.emailLeung, WK:waikleung@hku.hken_US
dc.identifier.authorityLeung, WK=rp01479en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/j.cgh.2008.08.044en_US
dc.identifier.pmid18955161en_US
dc.identifier.scopuseid_2-s2.0-60949084361en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-60949084361&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume7en_US
dc.identifier.issue3en_US
dc.identifier.spage311en_US
dc.identifier.epage316en_US
dc.identifier.isiWOS:000264368200013-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridChiu, PWY=7103182534en_US
dc.identifier.scopusauthoridNg, EKW=24328695100en_US
dc.identifier.scopusauthoridCheung, FKY=7102329452en_US
dc.identifier.scopusauthoridChan, FKL=7202586434en_US
dc.identifier.scopusauthoridLeung, WK=7201504523en_US
dc.identifier.scopusauthoridWu, JCY=7409253910en_US
dc.identifier.scopusauthoridWong, VWS=7202525502en_US
dc.identifier.scopusauthoridYung, MY=7101896866en_US
dc.identifier.scopusauthoridTsoi, K=16065259000en_US
dc.identifier.scopusauthoridLau, JYW=13907867100en_US
dc.identifier.scopusauthoridSung, JJY=35405352400en_US
dc.identifier.scopusauthoridChung, SSC=7404292955en_US

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