The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015.
Endoscopy
; 53(12): 1210-1218, 2021 12.
Article
em En
| MEDLINE
| ID: mdl-33601430
ABSTRACT
BACKGROUND:
Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported.METHODS:
This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality.RESULTS:
242 796 patients with an UGIB admission were identified (58.8â% men; median age 70 [interquartile range (IQR) 53â-â81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5â% to 7.0â%; Pâ<â0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95â% confidence interval [CI] 0.69â-â0.80; Pâ<â0.001), including from variceal bleeding (OR 0.63, 95â%CI 0.45â-â0.87; Pâ<â0.005). Increasing co-morbidity (Charlson score >â5, OR 2.94, 95â%CI 2.85â-â3.04; Pâ<â0.001), older age (>â83 years, OR 6.50, 95â%CI 6.09â-â6.94; Pâ<â0.001), variceal bleeding (OR 2.03, 95â%CI 1.89â-â2.18; Pâ<â0.001), and a weekend admission (Sunday, OR 1.18, 95â%CI 1.12â-â1.23; Pâ<â0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9â% were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95â%CI 1036.8â-â1353.8] per 100 000 men in 2003).CONCLUSIONS:
Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5â% to 7.0â%. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Varizes Esofágicas e Gástricas
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article