Risk factor analysis of mortality within 30 d after gastrointestinal bleeding in patients undergoing thoracotomy in cardiac surgery

Du Hailin; Sun Yamei; Zhang Jie

doi:10.3760/j.issn.1673-4777.2026.03.014

Abstract：Objective To investigate the risk factors for mortality within 30 d after gastrointestinal bleeding(GIB)in patients undergoing thoracotomy in cardiac surgery.Methods A total of 271 adult patients who under-went thoracotomy in the Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University and developed GIB within 30 d after surgery from January 2017 to January 2024 were retrospectively enrolled.All-cause mortality within 30 d after GIB was set as the primary endpoint.According to the occurrence of the primary endpoint event,the patients were divided into the survival group(149 cases)and the death group(122 cases).Univariate Logistic analysis was performed between the two groups,and then covariates were included to construct a multivariate Logistic model to identify the risk factors for mortality within 30 d after GIB.Results The proportions of female patients,peripheral vascular disease,European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ),rethoracotomy before bleeding,cerebrovascular disease before bleeding,pulmonary infection before bleeding,shock before bleeding,vasoactive drug support before bleeding,mechanical ventilation before bleeding,continuous renal replacement therapy before bleeding,intra-aortic balloon pump or extracorporeal membrane oxygenation before bleeding,red blood cell transfusion volume before bleeding,stable international normalized ratio(INR)before bleeding,and the first INR after bleeding in the death group were significantly higher than those in the survival group,while the proportion of hypertension,stable platelet count before bleeding,systolic blood pressure at the time of bleeding,and the first platelet count after bleeding in the death group were significantly lower than those in the survival group(all P＜0.05).Multivariate Logistic regression analysis showed that peripheral vascular disease was an independent risk factor for mortality within 30 d after GIB in patients undergoing thoracotomy in cardiac surgery(odds ratio=2.77,95％confidence interval:1.28-6.19,P=0.011).Every 10 mmHg increase in systolic blood pressure at the time of bleeding(1 mmHg=0.133 kPa,odds ratio=0.74,95％confidence interval:0.63-0.85,P＜0.001)and every 50 × 109/L increase in the first platelet count after bleeding(odds ratio=0.73,95％confidence interval:0.61-0.86,P＜0.001)were associated with a decreased risk of mortality.Conclusion In patients undergoing thoracotomy in cardiac surgery complicated with GIB,peripheral vascular disease is independently associated with an increased risk of mortality within 30 d after GIB,while higher systolic blood pressure at the time of bleeding and higher first platelet count after bleeding are associated with a decreased risk of mortality within 30 d after GIB.