Risk factors for death in patients with acute upper gastrointestinal bleeding

Tu Jia-hong; Zhang Ming-qing; Zhao Bin

doi:10.3969/j.issn.1002-1949.2018.02.013

Abstract：Objective To analyze the risk factors for death in patients with acute upper gastrointestinal bleeding, and to predict its mortality. Methods The clinical data including clinical features,previous history, examination, and treatment of the patients with acute upper gastrointestinal bleeding in our hospital from January 2013 to July 2017 were analyzed. All the patients were divided into non-Liver Disease group and Liver Disease group according to chronic liver disease. Then the patients with liver disease were divided into death group and survival group based on the death occurring in hospital or within 30 days after admission. Univariate comparison analyses were performed to evaluate the differences between the groups. And the survival curves and ROCs were plotted. Respectively calculated their AIMS65, Glasgow - Blachford(GBS), Pre - Rockall scores and ALBI scores, took the in -hospital/30-days death as the study endpoint. Compared the clinical value of the four scores by plotting their ROCs and calculating the AUC. Results Among the 240 eligible patients, there were 179 (74.58%) in non-Liver Disease group and 61(25.42%) in Liver Disease group. Their mortality was 2.79% (5 deaths) and 26.2% (16 deaths)(P <0.05), respectively. The survival rate of Liver Disease group in 2 -5 days was significantly lower than that of non - Liver Disease group. In liver disease group, the age, hematemesis, consciousness disorder, syncope and total bilirubin elevation showed significantly difference in the death and survival group (all P < 0. 05). The ALBI score effectively predicted the mortality of patients both in the overall patient and Liver Disease group(AUC>0.8) and was comparable to the AMIS65 and Pre-Rockall score. But in the non-liver disease group, AUC of ALBI score was 0.742, lower than the other three scoring systems. Conclusion The risk factors for death of acute upper gastrointestinal bleeding include history of liver disease, old age, hematemesis,consciousness disorder and elevated blood bilirubin. ALBI score, AMIS65 score, Pre-Rockall scorecan effectively predict mortality, and ALBI score is more simple and objective, which is suitable for the rapid assessment of the emergency department.