Rebleeding in peptic ulcer bleeding - a nationwide cohort study of 19,537 patients.
Scand J Gastroenterol
; 57(12): 1423-1429, 2022 12.
Article
em En
| MEDLINE
| ID: mdl-35853234
ABSTRACT
BACKGROUND:
Rebleeding is a frequent complication of peptic ulcer bleeding (PUB). The associated prognosis remains rather unclear because previous studies generally also included non-ulcer lesions.OBJECTIVE:
We aimed to identify predictors for rebleeding; clarify the prognostic consequence of rebleeding; and develop a score for predicting rebleeding.METHODS:
Nationwide cohort study of consecutive patients presenting to hospital with PUB in Denmark from 2006-2014. Logistic regression analyses were used to identify predictors for rebleeding, evaluate the association between rebleeding and 30-day mortality, and develop a score to predict rebleeding. Patients with persistent bleeding were excluded.RESULTS:
Among 19,258 patients (mean age 74 years, mean ASA-score 2.4), 10.8% rebled, and 10.2% died. Strongest predictors for rebleeding were endoscopic high-risk stigmata of bleeding (Odds Ratio (OR) 2.12 [95% Confidence Interval (CI) 1.91-2.36]), bleeding from duodenal ulcers (OR 1.87 [95% CI 1.69-2.08]), and presentation with hemodynamic instability (OR 1.55 [95% CI 1.38-1.73]). Among patients with all three factors (7.9% of total), 24% rebled, 50% with rebleeding failed endoscopic therapy, and 23% died. Rebleeding was associated with increased mortality (OR 2.04 [95% CI 1.78-2.32]). We were unable to develop an accurate score to predict rebleeding.CONCLUSION:
Rebleeding occurs in â¼10% of patients with PUB and is overall associated with a two-fold increase in 30-day mortality. Patients with hemodynamic instability, duodenal ulcers, and high-risk endoscopic stigmata are at highest risk of rebleeding. When rebleeding occurs in such patients, consultation with surgery and/or interventional radiology should be obtained prior to repeat endoscopy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hemostase Endoscópica
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Úlcera Duodenal
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article