Rebleeding in peptic ulcer bleeding - a nationwide cohort study of 19,537 patients
BACKGROUND: Rebleeding is a frequent complication of peptic ulcer bleeding (PUB). The associated prognosis remains rather unclear because previous studies generally also included non-ulcer lesions.
OBJECTIVE: We aimed to identify predictors for rebleeding; clarify the prognostic consequence of rebleeding; and develop a score for predicting rebleeding.
METHODS: Nationwide cohort study of consecutive patients presenting to hospital with PUB in Denmark from 2006-2014. Logistic regression analyses were used to identify predictors for rebleeding, evaluate the association between rebleeding and 30-day mortality, and develop a score to predict rebleeding. Patients with persistent bleeding were excluded.
RESULTS: Among 19,258 patients (mean age 74 years, mean ASA-score 2.4), 10.8% rebled, and 10.2% died. Strongest predictors for rebleeding were endoscopic high-risk stigmata of bleeding (Odds Ratio (OR): 2.12 [95% Confidence Interval (CI): 1.91-2.36]), bleeding from duodenal ulcers (OR: 1.87 [95% CI: 1.69-2.08]), and presentation with hemodynamic instability (OR: 1.55 [95% CI: 1.38-1.73]). Among patients with all three factors (7.9% of total), 24% rebled, 50% with rebleeding failed endoscopic therapy, and 23% died. Rebleeding was associated with increased mortality (OR: 2.04 [95% CI: 1.78-2.32]). We were unable to develop an accurate score to predict rebleeding.
CONCLUSION: Rebleeding occurs in ∼10% of patients with PUB and is overall associated with a two-fold increase in 30-day mortality. Patients with hemodynamic instability, duodenal ulcers, and high-risk endoscopic stigmata are at highest risk of rebleeding. When rebleeding occurs in such patients, consultation with surgery and/or interventional radiology should be obtained prior to repeat endoscopy.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
|---|---|
| Enthalten in: |
Scandinavian journal of gastroenterology - 57(2022), 12 vom: 05. Dez., Seite 1423-1429 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Laursen, Stig B [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 01.12.2022 Date Revised 06.12.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1080/00365521.2022.2098050 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM34373348X |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM34373348X | ||
| 003 | DE-627 | ||
| 005 | 20231226021134.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1080/00365521.2022.2098050 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1145.xml |
| 035 | |a (DE-627)NLM34373348X | ||
| 035 | |a (NLM)35853234 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Laursen, Stig B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Rebleeding in peptic ulcer bleeding - a nationwide cohort study of 19,537 patients |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.12.2022 | ||
| 500 | |a Date Revised 06.12.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Rebleeding is a frequent complication of peptic ulcer bleeding (PUB). The associated prognosis remains rather unclear because previous studies generally also included non-ulcer lesions | ||
| 520 | |a OBJECTIVE: We aimed to identify predictors for rebleeding; clarify the prognostic consequence of rebleeding; and develop a score for predicting rebleeding | ||
| 520 | |a METHODS: Nationwide cohort study of consecutive patients presenting to hospital with PUB in Denmark from 2006-2014. Logistic regression analyses were used to identify predictors for rebleeding, evaluate the association between rebleeding and 30-day mortality, and develop a score to predict rebleeding. Patients with persistent bleeding were excluded | ||
| 520 | |a RESULTS: Among 19,258 patients (mean age 74 years, mean ASA-score 2.4), 10.8% rebled, and 10.2% died. Strongest predictors for rebleeding were endoscopic high-risk stigmata of bleeding (Odds Ratio (OR): 2.12 [95% Confidence Interval (CI): 1.91-2.36]), bleeding from duodenal ulcers (OR: 1.87 [95% CI: 1.69-2.08]), and presentation with hemodynamic instability (OR: 1.55 [95% CI: 1.38-1.73]). Among patients with all three factors (7.9% of total), 24% rebled, 50% with rebleeding failed endoscopic therapy, and 23% died. Rebleeding was associated with increased mortality (OR: 2.04 [95% CI: 1.78-2.32]). We were unable to develop an accurate score to predict rebleeding | ||
| 520 | |a CONCLUSION: Rebleeding occurs in ∼10% of patients with PUB and is overall associated with a two-fold increase in 30-day mortality. Patients with hemodynamic instability, duodenal ulcers, and high-risk endoscopic stigmata are at highest risk of rebleeding. When rebleeding occurs in such patients, consultation with surgery and/or interventional radiology should be obtained prior to repeat endoscopy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Peptic ulcer hemorrhage (MeSH term) | |
| 650 | 4 | |a mortality (MeSH term) | |
| 650 | 4 | |a rebleeding | |
| 650 | 4 | |a risk assessment (MeSH term) | |
| 700 | 1 | |a Stanley, Adrian J |e verfasserin |4 aut | |
| 700 | 1 | |a Laine, Loren |e verfasserin |4 aut | |
| 700 | 1 | |a Schaffalitzky de Muckadell, Ove B |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Scandinavian journal of gastroenterology |d 1966 |g 57(2022), 12 vom: 05. Dez., Seite 1423-1429 |w (DE-627)NLM000055166 |x 1502-7708 |7 nnns |
| 773 | 1 | 8 | |g volume:57 |g year:2022 |g number:12 |g day:05 |g month:12 |g pages:1423-1429 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1080/00365521.2022.2098050 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 57 |j 2022 |e 12 |b 05 |c 12 |h 1423-1429 | ||