Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

Table 1 Predictors of recurrent bleeding after epinephrine injection therapy in the univariate analysis

	Sustained hemostasis	Recurrent bleeding	P value
Patient number	144	31
Age (yr)	63.7 (±14.4)	68.0 (±11.3)	0.035
< 60	55	5	0.019
≥ 60	89	26
Sex			0.375
Male	100	24
Female	44	7
ASA category			0.006
I, II	44	2
III, IV, V	100	29
Shock			0.003
Negative	119	18
Positive	25	13
Forrest class			0.973
Active bleeding (Ia, Ib)	98	21
Recent bleeding (IIa, IIb)	46	10
Ulcer size (cm)			1.0001
< 2	128	28
≥ 2	16	3
Injection approach			0.689
Easy	80	16
Difficult	64	15
Ulcer location			0.512
Stomach	79	15
Duodenum	65	16
Pre-endoscopic blood transfusion (mL)	658 ± 475	758 ± 463	0.277
< 1000	92	19	0.785
≥ 1000	52	12
Hemoglobin (g/dL)	9.5 ± 2.4	6.6 ± 1.7	< 0.001
≥ 8	104	6	< 0.001
< 8	40	25
Injection dose (mL)	8.7 ± 4.1	10.4 ± 5.0	0.057
< 12	127	21	0.011
≥ 12	17	10
Bleeding signs			< 0.001
Mild	119	16
Severe	25	15
Patient status			0.076
Outpatient	81	12
Inpatient	63	19
NSAID/aspirin			0.738
User	51	10
Non-user	93	21

¹The value was obtained according to Fisher's exact test based on an expectation value < 5. NASID: Nonsteroidal anti-inflammatory drug.

Table 2 Predictors of recurrent bleeding after epinephrine injection therapy from stepwise logistic regression in the multivariate analysis

	Odds ratio	95% CI	P value
Age (yr)
≥ 60 vs < 60	5.11	1.34-19.48	0.017
Hemoglobin (g/dL)
< 8 vs≥ 8	13.44	4.29-42.13	< 0.001
Bleeding signs
Severe vs mild	5.46	1.89-15.79	0.002
Injection dose (mL)
≥ 12 vs < 12	5.72	1.69-19.38	0.005

Variables of P < 0.4 were used in the multivariate analysis. CI: Confidence interval.

Table 3 The outcome of 31 patients with rebleeding after initial hemostasis using epinephrine injection therapy

Outcome of rebleeding patients	No. of patients (n = 31)
Surgery	10 (32.2%)
Major complications1	15 (48.4%)
Sepsis	8
Renal failure	2
Respiratory failure	8
Hypovolemic shock	2
Death	13 (41.9%)

¹Some patients suffered 2 or more major complications related to recurrent bleeding.