The In-hospital Mortality Rate in Gastrointestinal Hemorrhage with Shock: A Nationwide Analysis

Abstract

Introduction: Gastrointestinal bleeding that requires hospitalization leads to significant morbidity and mortality in the United States. Although incidence of hospital admissions due to upper GI bleeding is four to five times higher than lower GI bleeding yet mortality rate for both have been reported about the same ranging between 10 - 24% in both groups. However, only limited mortality data is available in such patients who have shock. We wanted to study mortality in both upper and lower GI bleed especially in patients especially those who had shock Methods: We conducted a retrospective analysis using the 2009-2013 Healthcare Cost and Utilization Project -Nationwide Inpatient Sample (HCUP-NIS). GI bleeding patients were identified by CCS diagnosis code 153. Upper GI bleed, lower GI bleed and patients in shock in each category were identified using ICD-9 diagnostic codes. We used SAS survey frequency procedure with discwt HCUP variable as weight to get national estimates. Chi-square test was used for comparison of categorical data.Figure 1Results: Our analysis consisted of about 1.82 million (1829295) cases with primary admission diagnosis of GI bleeding over five years. Overall, all-cause mortality rate in patients with shock was 17% compared to 2.2% in those without shock. Subgroup analysis by type of GI bleeding showed that mortality in cases of Upper GI bleeding (UGIB) with shock was 13.8 % compared to 1.88% in those without shock. Lower GI bleeding (LGIB) was noted to have all-cause mortality of 24.3 % in shock versus 2.67 % in those without shock. p- value for all observation was less than 0.0001. Conclusion: Our analysis showed that overall mortality rate in lower GI bleeding is higher than upper GI bleeding but mortality rate is much higher in patients with shock in both groups and early goal directed therapy might lead to improvement in mortality in this patient population.