Abstract
In the absence of interventional endoscopy, the treatment of upper digestive haemorrhages (HDH) at Brazzaville University Hospital is essentially medicinal. The objective of this work was to identify the risk factors for HDH mortality at Brazzaville University Hospital by conducting a retrospective prognostic case-control study over a period of 2 years, from January 2017 to December 2018. The 180 patients included in the study for an HDH were divided into 2 groups according to their evolutionary modality: deceased patients (cases) and non deceased patients (controls). The mortality risk factors were studied by logistic regression. Mortality related to upper digestive haemorrhages was 36.6%; the risk factors for death were age between 30 and 60 years with a (OR: 9.79; 95% CI [1.24 - 76.83]; p = 0.003); male sex (OR: 2.03; 95% CI [1.03 - 4]; p = 0.0393); late consultation beyond 24 hours (OR: 6.30; 95% CI [2.12 - 18.72]; p = 0.0009), blood transfusions (OR: 3.5; 95% CI [1.66 - 7.40]; p = 0.0001). Protective factors were haemoglobin greater than 7 g/dL (OR: 0.28; 95% CI [0.14 - 0.54]; p = 0.0001); treatment with proton pump inhibitors (OR: 0.36; 95% CI [0.15 - 0.84]; p = 0.0191). In conclusion, the reduction of the still high mortality rate in our country requires taking into account the identified risk factors and the acquisition of endoscopic haemostasis equipment.
Highlights
Upper digestive haemorrhages (HDH) are a medical-surgical emergency requiring rapid and appropriate treatment, often requiring endoscopic haemostasis
Mortality related to upper digestive haemorrhages was 36.6%; the risk factors for death were age between 30 and 60 years with a (OR: 9.79; 95% CI [1.24 - 76.83]; p = 0.003); male sex (OR: 2.03; 95% CI [1.03 - 4]; p = 0.0393); late consultation beyond 24 hours (OR: 6.30; 95% CI [2.12 - 18.72]; p = 0.0009), blood transfusions (OR: 3.5; 95% CI [1.66 - 7.40]; p = 0.0001)
Itoundi-Bignoumba et al in Gabon found mortality from upper digestive haemorrhage to be less than 3%
Summary
Upper digestive haemorrhages (HDH) are a medical-surgical emergency requiring rapid and appropriate treatment, often requiring endoscopic haemostasis. The prevalence of digestive haemorrhages varies from one country to another [1] [2] [3]. Itoundi-Bignoumba et al in Gabon found mortality from upper digestive haemorrhage to be less than 3%. This is the case in many countries [3]-[11] practising endoscopic haemostasis where the mortality rate is less than 10%. In order to contribute to improving the management of upper gastrointestinal haemorrhages (HDH), we carried out this work, the objectives of which were to determine the mortality rate from HDH and to identify the risk factors for mortality during HDH
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