Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding

Table 10 Studies regarding predictors of rebleeding and mortality in patients with upper digestive bleeding (nonvariceal/all causes)

Study	Yr	Condition	Type of study		No. of patients	Mean age (yr)	Mortality rate, (%)	Rebleeding rate (%)	Predictive factors for mortality	Odds ratio, (OR)	Predictive factors for rebleeding	Odds ratio, (OR)	Surgery (%)
			Prospective/retrospective	Uni-/multicentric
Barkun et al[1]	2004	NVUDB	R	M	869	66 ± 17	5.4	14.1	(1) PPI use; (2) Endoscopic therapy	(1) 0.18; (2) 0.31	(1) PPI use; (2) Endoscopic 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 postprocedure; (2) Endo-scopically demonstrated bleeding; (3) Hemostasis with epineph-rine monotherapy; (4) Postprocedure i.v or LMWH use; (5) Moderate/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 endoscopic treatment)	(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) Rebleeding; (4) Rockall score preendoscopy; (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 (inhospital 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 transfusions; (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) Neoplasia; (3) Multiple comorbidities; (4) Shock at admission; (5) Early rebleeding	(1) 2.19; (2) 2.7; (3) 5.04; (4) 4.55; (5) 1.47	14.3 (of early rebleeders)
Taha et al[13]	2014	UDB	R	U	2669	NA	7.1		(1) Age; (2) Charlson score; (3) Rockall score; (4) Units of blood transfused	(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 instability on presentation; (2) ASA class 3 or 4; (3) Low-dose aspirin use; (4) History of peptic ulcer; (5) Rebleeding; (6) Failed endoscopic 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) Metastatic malignancy; (3) Age ≥ 65 yr; (4) Hypotension	(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 instability; (3) Serum BUN levels > 40 mg/dL; (4) Active bleeding at endoscopy; (5) Transfusions; (6) Comorbidities; (7) Rebleeding	(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 embolisation)

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.