Year 2019 / Volume 111 / Number 3
Original
Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series

189-192

DOI: 10.17235/reed.2018.5702/2018

Rita Jiménez Rosales, Juan Gabriel Martínez-Cara, Francisco Vadillo-Calles, Eva Julissa Ortega-Suazo, Patricia Abellán-Alfocea, Eduardo Redondo-Cerezo,

Abstract
Background: upper gastrointestinal bleeding (UGIB) is one of the main causes of hospital admission in gastroenterology departments and is associated with a significant morbidity and mortality. Rebleeding after initial endoscopic therapy occurs in 10-20% of cases and therefore, there is a need to define predictive factors for rebleeding. Aim: the aim of our study was to analyze risk factors and outcomes in a population of patients who suffered a rebleed. Methods: five hundred and seven patients with gastrointestinal bleeding were included. Clinical and biochemical data, as well as procedures and outcome six months after admission, were all collected. Documented clinical outcome included in-hospital and six-month delayed mortality, rebleeding and six-month delayed hemorrhagic and cardiovascular events. Results: according to a logistic regression analysis, high creatinine levels were independent risk factors for rebleeding of non-variceal and variceal UGIB. In non-variceal UGIB, tachycardia was an independent risk factor, whereas albumin levels were an independent protective factor. Rebleeding was associated with in-hospital mortality (29.5% vs 5.5%; p < 0.0001). In contrast, rebleeding was not related to six-month delayed mortality or delayed cardiovascular and hemorrhagic events. Conclusions: tachycardia and high creatinine and albumin levels were independent factors associated with rebleeding, suggestive of a potential predictive role of these parameters. The incorporation of these variables into predictive scores may provide improved results for patients with UGIB. Further validation in prospective studies is required.
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References
1. Saltzman JR. Advances and Improvements in the Management of Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am. 2015; 25: xv-xvi
2. Monteiro S, Gonçalves TC, Magalhães J, et al. Upper gastrointestinal bleeding risk scores: Who, when and why? World J Gastroint Pathophysiol. 2016; 7:86-96.
3. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc 2015 ;81:882-8.
4. Rockall TA, Logan RF, Devlin HB et al. Selection of patients for early discharge or outpatient care 
after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal 
Haemorrhage. Lancet 1996; 347: 1138-40.
5. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356: 1318-21.
6. Saltzman JR, Tabak YP, Hyett BH et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011; 74: 1215-24.
7. Ramaekers R, Mukarram M, Smith CA, et al. The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review. Acad Emerg Med. 2016; 23:1218-27.
8. Lip HT, Heah HT, Huei TJ, et al. Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population. Med J Malaysia 2016; 71:225-30.
9. Lee HH, Park JM, Lee SW, et al. C-reactive protein as a prognostic indicator for rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Dig Liver Dis 2015; 47:378-83.
10. García-Iglesias P, Villoria A, Suarez D, et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011; 34: 888–900.
11. Lee YJ, Kim ES, Hah YJ, et al. Chronic Kidney Disease, Hemodynamic Instability, and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding. J Korean Med Sci. 2013; 28:1500-1506.
12. Kumar S, Asrani SK, Kamath PS. Epidemiology, Diagnosis and Early Patient Management of esophagogastric Hemorrhage. Gastroenterol Clin N Am 2014; 43: 765-82.
13. Odutayo A, Desborough MJ, Trivella M, et al. Restrictive versus liberal blood trasnfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol 2017; 2:354-60.
14. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015 Oct;47(10):a1-46.
15. Cárdenas A, Baiges A, Hernández-Gea V, García-Pagán JC. Endoscopic Hemostasis in Acute Esophageal Variceal Bleeding. Gastroenterol Clin N Am. 2014; 43: 795-806.
16. Camus M, Jensen DM, Kovacs TO, et al. Independent risk factors of 30-day outcomes in 1264 patients with peptic ulcer bleeding in the USA - large ulcers do worse. Aliment Pharmacol Ther. 2016; 43:1080-9.
17. Mostafa EF, Mohammad AN. Incidence and predictors of rebleeding after band ligation of oesophageal varices. Arab J Gastroenterol. 2014; 15:135-41.
18. Suk KT, Kim HS, Lee CS, et al. Clinical outcomes and risk factors of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. Clin Endosc. 2011; 44: 93-100.
19. Crooks CJ, Card TR, West J. Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study. PLoS Med. 2013;10(4):e1001437.
20. Stanley AJ, Laine L,Dalton HR, et al. Comparision of risk scoring system for patients presenting with upper gastrointestinal bleeding: international multicentre porspective study. BMJ 2017; 356:i6432.
21. Hoffmann V, Neubauer H, Heinzler J, et al. A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding: Cologne-WATCH (C-WATCH) Risk Score. Medicine (Baltimore) 2015: 94:e1614.
22. Tung CF, Chow WK, Chang CS, et al. The prevalence and significance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding. Hepatogastroenterology 2007; 54:1153-6.
23. González-González JA, Vázquez-Elizondo G, Monreal-Robles R, et al. Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding. Rev Gastroenterol Mex. 2016; 81:183-9.
24. Montaño Loza A. Clinical impact of serum albumin on non variceal upper gastrointestinal bleeding. Rev Gastroentesterol Mex 2016; 81:181-2.
25. González-González JA, Monreal-Robles R, García-Compean D, et al. Nonvariceal upper gastrointestinal bleeding in the elderly: clinical outcomes and prgnosis factors. J Dig Dis. 2017; 18: 212-21.
26. Gonzalez-Gonzalez JA, Garcia-Compean D, Vazquez-Elizondo G, et al. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Ann Hepatol 2011; 10: 287-95.
27. Laine L, Laursen SB, Dalton HR, et al. Relationship of time to presentation after onset of uper GI bleeding with patient characteristics and outcome: a prospective study. Gastrointest Endosc. Epub ahead of print 7 April 2017. DOI: 10.1016/j.gie.2017.03.1549.
28. Zhou JN, Wei Z, Sun ZQ. Risk factors for early rebleeding after esophageal variceal ligation in patients wit liver cirrosis. Zhonghua Gan Zang Bing Za Zhi 2016;24:486-92.
29. Zou D, Qi X, Zhu C, et al. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study. Turk J Gastroenterol 2016;27:180-6
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Jiménez Rosales R, Martínez-Cara J, Vadillo-Calles F, Ortega-Suazo E, Abellán-Alfocea P, Redondo-Cerezo E, et all. Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series. 5702/2018


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Publication history

Received: 06/05/2018

Accepted: 15/09/2018

Online First: 10/12/2018

Published: 04/03/2019

Article revision time: 130 days

Article Online First time: 218 days

Article editing time: 302 days


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