Analysis Of Risk Factors Related To Prognosis Of Acute Upper Gastrointestinal Bleeding

Background:Acute upper gastrointestinal bleeding(AUGIB)is one of the most common acute and severe diseases in clinic.The disease progresses rapidly and is often accompanied by decreased blood volume and peripheral circulatory failure.Although the incidence has declined gradually in recent years,the in-hospital fatality rate remains between 1.9and 10%.Despite the development of endoscopic hemostasis and adjuvant drug therapy,the fatality rate is still quite high and the medical costs are high,with the annual incidence of acute upper gastrointestinal bleeding in adults ranging from 100/100,000 to 18/100,000.This may be related to the aging of the population,multiple comorbiditiesand the use of NSAIDs and anticoagulants.The clinical characteristics of patients and the severity of the disease play an important role in AUGIB,and its mortality is usually associated with multiple organ failure,poor cardiopulmonary function,and malignant tumors.Therefore,early identification of risk factors for inhospital death of AUGIB,fluid resuscitation,and maintenance of hemodynamic stability,pharmacotherapy,and endoscopic hemostasis will improve patient outcomes.Objective:To analyze the clinical characteristics of acute upper gastrointestinal bleeding,to explore the mortality related risk factors in AUGIB patients,and to compare the predictive value of AIMS65 score,Rockall score and Blatchford score in the mortality risk of NVUGIB patients.Methods:AUGIB patients admitted to the Third People’s Hospital of Huizhou City from January 2019 to February 2021 were retrospectively analyzed.All the patients meeting the inclusion criteria were divided into the death group and the survival group,and gender,age,smoking history,drinking history,heart rate,systolic blood pressure,complicated diseases(coronary heart disease,hypertension,diabetes,renal insufficiency),blood routine,blood coagulation,biochemical indicators were counted respectively.Univariate analysis was conducted for each variable,and the influencing factors with statistical significance and clinical significance were further analyzed by binary logistic regression.According to the results,relevant risk factors affecting the death of AUGIB patients were obtained.AIMS65 score,Rockall score and Blatchford score were performed for all NVUGIB patients in the sample,and receiver operating characteristic curve(ROC curve)was drawn respectively.The area under the curve(AUC)of AIMS65 score,Rockall score and Blatchford score was compared.To determine the predictive ability of AIMS65 score,Rockall score,and Blatchford score on mortality risk in patients with NVUGIB.Results:1.A total of 264 patients met the criteria,including 9 in the death group and 255 in the survival group,with an in-hospital fatality rate of 3.4%.The common causes of AUGIB patients were duodenal ulcer(151 cases,57.2%),esophageal and gastric varices(41 cases,15.5%),gastric ulcer(39 cases,14.8%),and acute gastric mucosal lesions(9 cases,3.4%).2.Univariate analysis showed that there were statistically significant differences in coronary heart disease,heart rate,systolic blood pressure,hemoglobin,serum albumin,urea nitrogen and active bleeding after admission(P < 0.10).There was no significant difference in age,sex,alcohol consumption,smoking,heart rate,creatinine,INR,and complications(hypertension,diabetes,renal insufficiency)(P >0.10).Combined with the clinical significance and foreign literature reports,age was also included as an influencing factor for the mortality of AUGIB patients.Eight influencing factors,including age,coronary heart disease,heart rate,systolic blood pressure,hemoglobin,serum albumin,urea nitrogen,and active bleeding after admission,were taken as independent variables,and prognosis(death or not)of patients with AUGIB was taken as dependent variable.The results of binary logistic regression analysis showed that systolic blood pressure,serum albumin,urea nitrogen and active bleeding after admission were related risk factors affecting the death of patients with AUGIB.3.The results of ROC curve showed that AUCAIMS65 < AUCBLACHFORD <AUCROCKALL,in which the Rockall score had the highest AUC value,but there was no statistically significant difference in AUC value among scores(P > 0.05).Conclusions:1.In AUGIB patients,the most common etiology is peptic ulcer,mainly duodenal ulcer;2.Systolic blood pressure,serum albumin,urea nitrogen and active bleeding after admission were the related risk factors affecting the death of AUGIB patients.3.AIMS65 score,Rockall score and Blatchford score can all predict the risk of death in NVUGIB patients well,and Rockall score has the highest accuracy in predicting the risk of death in NVUGIB patients,but there is no statistically significant difference in the accuracy of prediction among the three groups.