Clinical Predictors of Poor Outcomes Among Patients with Non-Variceal Upper Gastrointestinal Bleeding in Europe

Angel Lanas (1, 2) , Lars Aabakken (3) , Jorge Fonseca (4) , Zeynel A Mungan (5) , George V. Papatheodoridis (6) , Hubert Piessevaux (7) , Livio Cipolletta (8) , Javier Nuevo (9) , Monica Tafalla (9)

1 Gastroenterology
2 Medicine
3 Department of Medicine
4 Service of Gastroenterology
5 Department of Gastroenterohepatology
6 ACADEMIC DEPT. OF MEDICINE
7 Service de gastro-entérologie
8 Division of Gastroenterology
9 Epidemiology Unit

Background: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. Aim: To report outcomes and predictive factors for bleeding continuation/re-bleeding and mortality of NVUGIB in clinical practice in different European countries. Methods: This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re-bleeding, pharmacological treatment, surgery and mortality during 30-days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. Results: Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re-bleeding (range: 9-15.8%) or death (2.5-8%) at 30 days were explained by clinical factors (number of comorbidities, age >65 years, history of bleeding ulcers, in-hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high-risk stigmata. Conclusions: Differences in the outcomes of NVUGIB in clinical practice across some European countries are explained mainly by patient-related factors, and not management factors.

Mots clés: Medicine

Angel Lanas, Lars Aabakken, Jorge Fonseca, Zeynel A Mungan, George V. Papatheodoridis, et al.. Clinical Predictors of Poor Outcomes Among Patients with Non-Variceal Upper Gastrointestinal Bleeding in Europe. Alimentary Pharmacology and Therapeutics, 2011, 33 (11), pp.1225. ⟨10.1111/j.1365-2036.2011.04651.x⟩. ⟨hal-00630793⟩