Clinical Analysis Of End-Stage Renal Disease Combined With Acute Non-Variceal Upper Gastrointestinal Bleeding

Objective: Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common clinical complication of the gastrointestinal tract in patients with end-stage renal disease(ESRD).The incidence and the mortality of ANVUGIB in patients with end-stage renal disease(ESRD)are reported to be significantly higher than those in the general population.Although the clinical features of ANVUGIB are well understood,it is not yet known whether can also apply these features to ESRD patients as they tend to be more complex and have a more specific bleeding mechanism.Therefore,this study retrospectively analyses the clinical records of ESRD patients with ANVUGIB to investigate the common causes of bleeding and the risk factors for poor prognosis in ESRD combined with ANVUGIB,to provide a reference for early identification of high-risk patients and timely and appropriate clinical intervention in the future.Methods: 101 ESRD patients with ANVUGIB admitted to the Second Affiliated Hospital of Dalian Medical University from January 2013 to December 2022 were selected for a retrospective study.Firstly,the causes of bleeding were collected from all patients included in the study based on the gastroscopy results,and their composition and characteristics were analyzed.Secondly,patients were divided into two groups according to whether or not they rebleed during their hospital stay: the rebleeding group and the non-rebleeding group,comparing the clinical history between the two groups and analysing the independent risk factors for rebleeding in ESRD patients with combined ANVUGIB by binary Logistic regression.Patients were then divided into two other groups according to whether they died during their hospital stay: the death group and the survival group.The clinical history was compared between the two groups,and independent risk factors for death in ESRD patients with ANVUGIB were analysed by binary Logistic regression.Result: 1.A total of 101 ESRD patients with ANVUGIB were included in this study,the most common causes of bleeding in patients were: peptic ulcers(68 cases,67.3%),including gastric ulcers(44 cases,43.5%),duodenal bulb ulcers(15 cases,14.9%),compound ulcers(9 cases,8.9%),and other causes of bleeding in the following order were: acute gastric mucosal lesions(14 cases,13.9%),gastric cancer(8 cases,7.9%),oesophageal cardia tear(7 cases,6.9%),gastric vascular malformation(3 cases,3.0%)and oesophagitis(1 case,1%).2.Of the 101 ESRD patients with combined ANVUGIB included in this study,a total of 17 patients(16.8%)had rebleeding.Diabetes(OR=17.251;95%CI=2.950-100.879;P=0.002)and dialysis times(OR=1.315;95%CI=1.026-1.685;P=0.031)were independent risk factors for rebleeding following ANVUGIB in ESRD patients,as well as serum albumin was a protective factor(OR=0.749;95%CI=0.582-0.963;P=0.024)(all P < 0.05).The AUC value of the ROC curve for dialysis times predicting rebleeding was 0.785(95%CI=0.690-0.880;P<0.001).3.Of the 101 ESRD patients with combined ANVUGIB included in this study,a total of 18 patients(17.8%)eventually died.Rebleeding(OR=17.286;95%CI=1.588-188.107;P=0.019),coronary artery disease(OR=19.604;95%CI=1.279-300.555;P=0.033),sepsis(OR=106.813;95%CI=2.641-4319.510;P=0.013),and high AIMS65score(OR=8.353;95%CI=1.062-65.697;P=0.044)were independent risk factors for death following ANVUGIB in ESRD patients(all P<0.05),with sepsis being the risk factor with the most significant effect on end.The AUC value of the ROC curve for the AIMS65 score predicting death was 0.892(95%CI=0.813-0.971;P<0.001).Conclusion: In patients with ESRD,peptic ulcers remain the most common cause of bleeding in ANVUGIB,with gastric ulcers being more common.More attention should be paid to the stomach when performing an endoscopy.In clinical practice,combined diabetes and dialysis times are independent risk factors that can be used to assess the risk of rebleeding in ESRD patients with ANVUGIB,for which high serum albumin is a protective factor.Rebleeding and co-morbidities(coronary artery disease,sepsis)are independent risk factors that can be used to assess their mortality risk,with sepsis being the most significant,and particular attention should be paid to the presence of infection when dealing with these patients.In patients with ESRD,the AIMS65 score has clinical efficacy in predicting death,while the clinical value of the GBS score remains to be further validated.