Analysis Of Death-related Risk Factors Of Acute Upper Gastrointestinal Bleeding

Objectives:To analysis the overall Clinical features of Acute upper gastrointestinal bleeding (AUGIB), explore the death-related risk factors of AUGIB, and also evaluate the prognostic ability of the Glasgow Blatchford Score (GBS) to predict the mortality in patients with AUGIB.Methods:This was a retrospective analysis of the patients who diagnosed with AUGIB from the Second Affiliated Hospital of Suzhou University from January2011to December2012. Patients were divided into death group and survival group according to their outcome. The significant difference between two groups were further analyzed by Logistic regression to explore the risk factors associated with mortality of patients with AUGIB. The GBS and Rockall Score (RS) were calculated, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to verify the efficiency of these two risk scoring systems for mortality, then get the optimal cut-off value.Results:789patients were included,26in death group and763in survival group. Mortality rate was3.30%, average age was57.45±18.684with78.96%man.The etiology of the top four were:duodenal ulcer302cases (44.71%), esophageal varices142cases (20.96%), gastric ulcer112cases (16.51%), malignancies28cases (4.08%). Haematemesis, active bleeding, etiology, systolic blood pressure, blood urea nitrogen, hemoglobin, serum albumin were significantly different (P<0.05); But Age, sex, smoking history, drinking history, heart rate, history of bleeding, total bilirubin, INR, serum creatinine were no significant difference (P>0.05) between death group and survival group. Logistic regression showed that independent death risk factors of AUGIB included Haematemesis, active bleeding, etiology, systolic blood pressure, blood urea nitrogen and hemoglobin. Receiver operating characteristic curve (ROC) curve analysis found that the GBS (0.877[95%CI (0.799-0.954)]) performed as well as the RS (0.896[95%CI(0.810-0.982)])(P>0.05) for prediction of mortality in patients presenting with AUGIB and its optimal cut-off value was10, with the sensitivity84.62%and Specificity76.93%。Conclusions:Peptic ulcer is the most important etiology of AUGIB. Systolic blood pressure, blood urea nitrogen, hemoglobin, haematemesis, etiology, active bleeding were independent death risk factors of AUGIB. The Glasgow Blatchford Score performed as well as the Rockall score for prediction of mortality in patients presenting with AUGIB and its optimal cut-off value was10.