S707 Comparison of Outcomes Between Upper and Lower GI Bleed Patients: A Post-Hoc Analysis of Retrospective Study

Abstract

Introduction: Traditionally, lower gastrointestinal bleed (LGIB) patients tend to have a benign clinical course compared to those with upper gastrointestinal bleed (UGIB) patients leading to the over-utilization of resources in patients with UGIB. However, recent studies have reported similar clinical outcomes such as readmission and mortality rates, thereby challenging this view. Our study aimed to compare clinical outcomes between the two groups. Methods: This is a post-hoc analysis of a retrospective study on patients admitted with gastrointestinal bleed as their primary diagnosis to higher level of care from March, 2015 - March, 2021. Electronic medical records of patients above 18 years of age were reviewed. The patients were stratified into 2 groups: UGIB and LGIB. The outcomes analyzed included incidence of end organ damage (acute kidney injury and myocardial infarction), treatment modalities (conservative and/or endoscopic intervention), no. of patients requiring intensive care unit (ICU), hospital length of stay (LOS), 30-day mortality, and 90-day readmission rate. Pearson Chi-square and Mann Whitney U were applied to compare groups. p-value greater than 0.05 was considered significant. Results: Out of 207 eligible patients, 164 (79.2%) had UGIB, 34 (16.4%) LGIB, and remaining 9 (4.4%) had both. The latter were excluded from the analysis. Table illustrates baseline characteristics and outcomes. We did not observe any significant difference in the conservative treatment (transfusion requirement and antibiotics usage), endoscopic interventions, and time to scope between the two groups (p >0.05). Furthermore, there was no significant difference in no. of patients requiring ICU, hospital LOS, 30-day mortality, and 90-day readmission rates (due to UGIB and LGIB). Conclusion: Similar clinical outcomes were observed between the UGIB and LGIB patients in our study which is in line with the emerging data. Moreover, no difference was noted in the approach of treatment i.e., conservative and/or endoscopic. Our study also highlights that early endoscopic intervention and higher level of care may not be as necessary in all patients with UGIB. Table 1. - Illustrating the comparison of baseline characteristics, medical history, end organ damage (troponin leak and AKI), 30-day mortality, and 90-day readmission rates, between the with upper gastrointestinal bleed and lower gastrointestinal bleed Upper GI Bleed Lower GI Bleed p-value n (%) = 164 (79.2%) n, (%) = 34 (16.4%) Age, mean ± SD (median, IQR) 65.6 (55,77) 64.15 (51, 76.3) ns Gender Male 98 (47.3%) 25 (12.1%) Female 66 (31.9%) 9 (4.3%) ns Race ns Caucasian 104 (50.2%) 22 (10.6%) Black 23 (11.1%) 6 (2.9%) Hispanic 13 (6.3%) 2 (1.0%) Other including unavailable data 24 (11.6%) 4 (1.9%) History of HTN 92 (44.4%) 21 (10.1%) ns History of DM 39 (18.8%) 8 (3.9%) ns History of CAD 47 (22.7%) 14 (6.8%) ns History of NSTEMI/STEMI 13 (6.3%) 2 (1.0%) ns History of CKD 42 (20.3%) 8 (3.9%) ns History of Liver disease 35 (16.9%) 7 (3.4%) ns History of DVT/PE 16 (7.7%) 2 (1.0%) ns History of Smoking 74 (35.7%) 17 (8.2%) ns History of Alcohol use 76 (36.7%) 15 (7.2%) ns History of Illicit Drug use 7 (3.4%) 2 (1.0%) ns Personal history of GI tract cancer 14 (6.8%) 6 (2.9%) ns Family history of GI tract cancer 4 (1.9%) 8 (3.9%) 0.000 Use of NSAIDs 27 (16.8%) 3 (9.1%) ns Use of anticoagulants 49 (23.9%) 12 (5.9%) ns Use of antiplatelets 25 (27.6%) 14 (42.4%) ns Troponin leak 14 (6.8%) 3 (1.4%) ns AKI 48 (23.2%) 14 (6.8%) ns Antibiotics 32 (15.5%) 4 (1.9%) ns pRBC transfusion median (IQR) 3 (2,4) 3 (2,4.75) ns Endoscopic intervention 81 (39.1%) 13 (6.3)%) ns No. of patients requiring ICU 63 (30.4%) 8 (3.9%) ns Intubation during hospitalization 15 (7.2%) 0 (0.0%) ns Time to scope, mean ± SD (median, IQR) 1.35 ± 1.78 (1.0, 0.75-2.00) 1.72 ± 1.46 (1.0, 1-2) ns Alive at 30 days 142 (68.6%) 29 (14%) ns 90-day readmission due to GI Bleed 39 (18.8%) 7 (3.4%) ns NS – None significant; HTN – Hypertension; DM – Diabetes mellitus; CAD – coronary artery disease; HF – Heart Failure; AF – Atrial Fibrillation; CKD – Chronic Kidney Disease; DVT – Deep venous thrombosis; PE – Pulmonary embolism; NSAIDs – Non steroidal anti-inflammatory drugs; PPI – Proton Pump Inhibitors; AKI – Acute Kidney Injury; PRBC – Packed Red Blood Cells; ICU: Intensive Care Unit.