Table 10.
Studies regarding predictors of rebleeding and mortality in patients with upper digestive bleeding (nonvariceal/all causes)
| Study | Yr | Condi-tion |
Type of study |
No. of patients | Mean age (yr) | Mor-tality rate, (%) | Re-bleeding rate (%) | Predic-tive factors for mor-tality | Odds ratio, (OR) | Predic-tive factors for re-bleeding | Odds ratio, (OR) | Surgery (%) | |
| Prospective/retrospec-tive | Uni-/multicentric | ||||||||||||
| Barkun et al[1] | 2004 | NVUDB | R | M | 869 | 66 ± 17 | 5.4 | 14.1 | (1) PPI use; (2) Endo-scopic therapy | (1) 0.18; (2) 0.31 | (1) PPI use; (2) Endo-scopic hemostasis in patients with high risk stigmata | (1) 0.53; (2) 0.39 | 6.5 |
| Travis et al[6] | 2008 | NVUDB | R | M | 236 | 67 | NA | 7.1%, 16.4%, 37.0%, 75.0% and 100% for zero, one, two, three or four risk factors | NA | NA | (1) Use of PPI post-proce-dure; (2) Endo-scopically demon-strated bleeding; (3) Hemo-stasis with epineph-rine mono-therapy; (4) Post-proce-dure i.v or LMWH use; (5) Mode-rate/severe liver disease; (6) Peptic ulcer as the source of bleeding | (1) 0.25; (2) 2; (3) 3.35; (4) 8.09; (5) 4.92 | NA |
| Sung et al[7] | 2010 | PUB | P | U | 10428 | 61.0 (sur-vivors) | 6.23 | 2.93 | (1) Use of NSAIDs/ aspirin; (2) Active bleeding ulcer; (3) Cloth/vessel at the base of ulcer; (4) Hemodymamic shock (bleeding-related death) | (1) 3.70; (2) 12.96; (3) 12.29; (4) 3.75 | NA | NA | 2.8 (deaths during surgery) |
| 72.5 (deaths) | |||||||||||||
| Zhang et al[8] | 2010 | NVUDB | R | U | 223 | NA | NA | 19.3 (failure of endo-scopic treat-ment) | (1) No. of comorbidities > 1; (2) Spurting of blood | (1) 9.580; (2) 9.971 | (1) Shock; (2) History of GI bleeding; (3) PLT 100 x 109/L; (4) Active spurting of blood; (5) Large lesion size | (1) 3.058; (2) 2.809; (3) 0.067; (4) 10.390; (5) 7.111 | NA |
| González-González et al[9] | 2011 | NVUDB | P | U | 1077 | 58.8 ± 18.9 | 10.2 | 3.4 | (1) No. of comorbidities/patient; (2) Serum albumin level < 2.6 g/dL; (3) Re-bleeding; (4) Rockall score pre-endo-scopy; (5) Lengths of hospital stay | (1) 1.6; (2) 4.9; (3) 6.5; (4) 1.3; (5) 1.04 | NA | NA | 1.5 |
| Morales Uribe et al[10] | 2011 | UDB | P | M | 464 | 59.7 | 9.9 | 17.4 | (1) Bleeding site (in-hospital vs outpatients); (2) Comorbidities | (1) 2.4; (2) 2.5 | NA | NA | 2.2 |
| Nahon et al[11] | 2012 | UDB | P | M | 3298 | 63 ± 18 | 8.3 | 9.9 | (1) Rockall score; (2) Comorbidities; (3) SBP < 100 mmHg | (1) 2.8; (2) 3.6 (for each additio-nal comorbidity); (3) 2.1 | (1) Need for transfu-sions; (2) Hb < 10 g/dL; (3) Rockall score; (4) SBP < 100 mmHg; (5) Signs of recent bleeding | (1) 19.1; (2) 1.7; (3) 1.4 (for each point score increase); (4) 1.9; (5) 2.4 | NA |
| Del Piano et al[12] | 2013 | NVUDB | P | M | 1413 | (1) -66.5 ± 15.8 male; (2) -74.2 ± 14.6 female | 5.4 | 4 | NA | NA | (1) Female sex; (2) Neo-plasia; (3) Multiple comorbidities; (4) Shock at admis-sion; (5) Early re-bleeding | (1) 2.19; (2) 2.7; (3) 5.04; (4) 4.55; (5) 1.47 | 14.3 (of early rebleed-ers) |
| Taha et al[13] | 2014 | UDB | R | U | 2669 | NA | 7.1 | (1) Age; (2) Charlson score; (3) Rockall score; (4) Units of blood trans-fused | (1) 1.020; (2) 1.291; (3) 1.274; (4) 1.085 | NA | NA | 2.1 | |
| Marmo et al[14,15] | 2014 | NVUDB | P | M | 2317 | 67.9 ± 16.7 | 4.573 | 5.61 | (1) Hemodynamic insta-bility on presen-tation; (2) ASA class 3 or 4; (3) Low-dose aspirin use; (4) History of peptic ulcer; (5) Re-bleeding; (6) Failed endo-scopic treatment | (1) 7.311; 2.312; (2) 6.721; 3.892; (3) 0.121; 0.252; (4) 3.181; 1.542; (5) 5.222; 14.292 | NA | NA | (1) 1.51; (2) 22 |
| 3.42 | |||||||||||||
| Lee et al[16] | 2016 | NVUDB | P | U | 184 | 59.81 | 8.73 | 14.73 | (1) Diabetes mellitus; (2) Meta-static malignancy; (3) Age ≥ 65 yr; (4) Hypoten-sion | (1) 12.67; (2) 29.24; (3) 5.06; (4) 16.63 | NA | NA | NA |
| Hwang et al[17] | 2016 | NVUDB | P | M | 1584 | 65 | 3.43 | 7.3 | (1) Age > 65 yr; (2) Hemodynamic insta-bility; (3) Serum BUN levels > 40 mg/dL; (4) Active bleeding at endo-scopy; (5) Transfusions; (6) Comorbidities; (7) Re-bleeding | (1) 2.627; (2) 2.217; (3) 1.895; (4) 2.434; (5) 3.811; (6) 3.481; (7) 10.581 | NA | NA | 2.8 (surgery/ percutaneous embolisa-tion) |
1
bleeding occurs in patients already hospitalized for another condition;
2
in-hospital bleeding; 3 at 30-d from the bleeding episode. NA: Not available; NVUDB: Nonvariceal upper digestive bleeding; UDB: Upper digestive bleeding (all causes); PUB: Peptic ulcer bleeding; R: Retrospective study; P: Prospective study; U: Unicentric study; M: Multicentric study; PPI: Proton pump inhibitor; LMWH: Low molecular weight heparin; GI: Gastrointestinal; PLT: Platelets.