Risk Factors of Upper Gastrointestinal Bleeding in Patients Hospitalized in a Chronic Ward

Abstract

Objectives: Upper gastrointestinal (UGI) bleeding is one of the most frequent complications among patients who need long-term care in a chronic ward. In this retrospective study, we therefore investigated the characteristics of UGI bleeding among patients hospitalized on a chronic ward. Methods: A total of 173 patients admitted to the chronic ward of the Ren-Ai Branch, Taipei City Hospital, were retrospectively enrolled. These individuals consisted of 109 patients with UGI bleeding and 64 patients without UGI bleeding. The demographic data and clinical courses of these patients were compared. Results: There were 135 (78.0%) patients who needed long-term naso-gastric (NG) tube feeding. Patients with UGI bleeding had a significantly higher rate of NG tube placement than those without UGI bleeding (89.9% vs. 57.8%, p＜0.001). All 12 patients with uremia suffered from UGI bleeding. In addition, the presence of a NG tube (odds ratio, 6.19; 95% CI, 2.69-14.21, p＜0.001) and the presence of diabetes mellitus as a comorbidity (odds ratio, 2.63; 95% CI, 1.16-5.96, p=0.021) were independent risk factors associated with UGI bleeding. A total of 75 UGI bleeding associated lesions were observed among 53 patients who underwent upper gastrointestinal endoscopy. Esophagitis or an esophageal ulcer was the most frequent causes of UGI bleeding (36%). The overall mortality rate was 50.3%. However, only 3.5% of the patients died from uncontrolled bleeding. Conclusions: UGI bleeding occurs frequently in patients with chronic illness. The presence of a NG tube, uremia as a comorbidity and diabetes mellitus as a comorbidity were found to be risk factors associated with UGI bleeding. The most common source of UGI bleeding in patients who were undergoing NG tube feeding was esophagitis and/or esophageal ulcer.