Effects of anti‐thrombotic drugs on all‐cause mortality after upper gastrointestinal bleeding in Japan: A multicenter study with 2,205 cases

Abstract Background and Objectives Acute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB. Methods This was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding. Results Among the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675–0.768; P<0.001) and 0.711 (95% CI 0.663–0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624–0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569–0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70. Conclusion In patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.

Download Full-text

Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic: a prospective, multicentre feasibility study

Frontline Gastroenterology ◽

10.1136/flgastro-2021-101851 ◽

2021 ◽

pp. flgastro-2021-101851

Author(s):

Philip Dunne ◽

Victoria Livie ◽

Aaron McGowan ◽

Wilson Siu ◽

Sardar Chaudhary ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Descriptive Data ◽

Risk Threshold ◽

All Cause Mortality ◽

Risk Patients ◽

Rebleeding Rate ◽

Upper Gastrointestinal ◽

Related Mortality

ObjectiveDuring the COVID-19 pandemic, we extended the low-risk threshold for patients not requiring inpatient endoscopy for upper gastrointestinal bleeding (UGIB) from Glasgow Blatchford Score (GBS) 0–1 to GBS 0–3. We studied the safety and efficacy of this change.MethodsBetween 1 April 2020 and 30 June 2020 we prospectively collected data on consecutive unselected patients with UGIB at five large Scottish hospitals. Primary outcomes were length of stay, 30-day mortality and rebleeding. We compared the results with prospective prepandemic descriptive data.Results397 patients were included, and 284 index endoscopies were performed. 26.4% of patients had endoscopic intervention at index endoscopy. 30-day all-cause mortality was 13.1% (53/397), and 33.3% (23/69) for pre-existing inpatients. Bleeding-related mortality was 5% (20/397). 30-day rebleeding rate was 6.3% (25/397). 84 patients had GBS 0–3, of whom 19 underwent inpatient endoscopy, 0 had rebleeding and 2 died. Compared with prepandemic data in three centres, there was a fall in mean number of UGIB presentations per week (19 vs 27.8; p=0.004), higher mean GBS (8.3 vs 6.5; p<0.001) with fewer GBS 0–3 presentations (21.5% vs 33.3%; p=0.003) and higher all-cause mortality (12.2% vs 6.8%; p=0.02). Predictors of mortality were cirrhosis, pre-existing inpatient status, age >70 and confirmed COVID-19. 14 patients were COVID-19 positive, 5 died but none from UGIB.ConclusionDuring the pandemic when services were under severe pressure, extending the low-risk threshold for UGIB inpatient endoscopy to GBS 0–3 appears safe. The higher mortality of patients with UGIB during the pandemic is likely due to presentation of a fewer low-risk patients.

Download Full-text

Favorable Prognosis of Upper-Gastrointestinal Bleeding in 1041 Older Patients: Results of a Prospective Multicenter Study

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2008.02.064 ◽

2008 ◽

Vol 6 (8) ◽

pp. 886-892 ◽

Cited By ~ 20

Author(s):

S NAHON ◽

O NOUEL ◽

H HAGEGE ◽

P CASSAN ◽

A PARIENTE ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Multicenter Study ◽

Older Patients ◽

Upper Gastrointestinal Bleeding ◽

Prospective Multicenter Study ◽

Favorable Prognosis ◽

Upper Gastrointestinal

Download Full-text

Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan

BMJ Open ◽

10.1136/bmjopen-2015-010439 ◽

2016 ◽

Vol 6 (5) ◽

pp. e010439 ◽

Cited By ~ 7

Author(s):

Chih-Chia Liang ◽

Che-Yi Chou ◽

Chiz-Tzung Chang ◽

I-Kuan Wang ◽

Chiu-Ching Huang

Keyword(s):

Chronic Kidney Disease ◽

Risk Factor ◽

Cohort Study ◽

Kidney Disease ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

All Cause Mortality ◽

Upper Gastrointestinal

Download Full-text

A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the “GRAPHE” registry)

Endoscopy ◽

10.1055/s-0042-116148 ◽

2016 ◽

Vol 48 (12) ◽

pp. 1084-1095 ◽

Cited By ~ 49

Author(s):

Sami Haddara ◽

Jeremie Jacques ◽

Stéphane Lecleire ◽

Julien Branche ◽

Sarah Leblanc ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Multicenter Study ◽

Upper Gastrointestinal Bleeding ◽

Hemostatic Powder ◽

Upper Gastrointestinal

Download Full-text

Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study

Gut ◽

10.1136/gutjnl-2020-323054 ◽

2021 ◽

pp. gutjnl-2020-323054

Author(s):

Cosmos L T Guo ◽

Sunny H Wong ◽

Louis H S Lau ◽

Rashid N S Lui ◽

Joyce W Y Mak ◽

...

Keyword(s):

Cohort Study ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Therapeutic Endoscopy ◽

Public Hospitals ◽

Icu Admission ◽

Acute Upper Gastrointestinal Bleeding ◽

Early Endoscopy ◽

All Cause Mortality ◽

Upper Gastrointestinal

ObjectiveWhile it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.DesignWe conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Adult patients (age ≥18) that presented with AUGIB between 2013 and 2019 and received therapeutic endoscopy within 48 hours (n=6474) were recruited. Patients were classified based on endoscopic timing postadmission: urgent (t≤6), early (6<t≤24) and late (24<t≤48). Baseline characteristics were balanced with inverse probability of treatment weighting. 30-day all-cause mortality, repeated therapeutic endoscopy rate, intensive care unit (ICU) admission rate and other endpoints were compared.ResultsResults showed that urgent timing (n=1008) had worse outcomes compared with early endoscopy (n=3865), with higher 30-day all-cause mortality (p<0.001), repeat endoscopy rates (p<0.001) and ICU admission rates (p<0.001). Late endoscopy (n=1601) was associated with worse outcomes, with higher 30-day mortality (p=0.003), in-hospital mortality (p=0.022) and 30-day transfusion rates (p=0.018).ConclusionCompared with urgent and late endoscopy among patients who have received therapeutic endoscopies, early endoscopy was associated with superior outcomes especially among patients with non-variceal bleeding. This supports the notion that non-variceal AUGIB patients should receive endoscopy within 24 hours, but also emphasises the importance of prior resuscitation and pharmacotherapy.

Download Full-text