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
2011 Impact Factor: 5.627
2011 SCImago Journal Rankings: 0.389
DOIhttp://dx.doi.org/10.1016/j.cgh.2008.08.044
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 5.627
2011 SCImago Journal Rankings: 0.389
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
Author Affiliations
  1. Prince of Wales Hospital Hong Kong