Risk Score and Predictive Models of Mortality From Non Variceal Acute Upper Gastrointestinal Haemorrhage in Italy: A National Survey

Abstract

Mortality associated with acute upper gastrointestinal bleeding is described high despite advances in diagnosis and therapy but, at our knowledge, study on the recent epidemiology, of acute upper gastrointestinal haemorrhage, on PPI epoch, are few Endoscopic and more recent pharmacologic treatment has recently been shown to reduce rebleeding rates and perhaps mortality. These advances in therapy are becoming more widely adopted and may influence the outcomes of patients with upper gastro intestinal bleeding (UGIB). Aim of the study was 1) verify the mortality rate of patients with UGIB in a nationwide survey, 2) evaluate the treatment role on the outcomes considered, 3) provide a predictive model of mortality taking in account also the therapeutic role. The data presented were collected over 12 months as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. From march 2003 to march 2004 a population based, unselected, multicentre, prospective survey, with 175 items, was conducted from 23 hospitals receiving emergency admissions in various regions equally distributed. 1175 cases of acute upper gastrointestinal haemorrhage ,in which patients aged from 10 to 99 years old, were identified. Results: the mean age was 67,03 ± 15,76 SD range 10-99, males account for 62% of the serie. Non variceal bleeding (NVB) is the main cause of bleeding in 86,8% (1020 patients). The main co-morbities was hypertension 29.3% and neoplasia was present in 7.8%; Endoscopic treatment was not done in 523 (51.3%); when employed, the more frequent was injection with adrenaline solution 319 (64.2%). After endoscopy the main used pharmacological treatment was proton pump inhibitors 76.7%, while H2 antagonists used in. 3.9% Overall mortality rate was 4,5%. Of the 175 items analyzed, 14 give independent gain in the mortality predictive model: ASA class, time to recovery, age, blood pressure, cardiac frequency, haemoglobin value, neoplasia, renal failure, cirrhosis, hematemesis, blood in gastric lumen, active bleeding, endoscopic treatment failure, and rebleeding. The area under the Roc curve give a .847 value that is one of the most relevant predictive model proposed. Conlusion mortality rate from UGIB in Italy is not so high but rise with age and comorbities. The challenge is to identify those patients who have most high risk for death so that their treatment and survelliance can be optimized. Various risk.