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Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe

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Lanas, A Aabakken, L Fonseca, J Mungan, Z A Papatheodoridis, G V Piessevaux, Hubert [UCL] Tafalla, M

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. AIM: To report outcomes and predictive factors for bleeding continuation/re-bleeding and mortality of NVUGIB in clinical practice in different European countries. METHODS: This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re-bleeding, pharmacological treatment, surgery and mortality during 30-days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. RESULTS: Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re-bleeding (range: 9-15.8%) or death (2.5-8%) at 30 days were explained by clinical factors (number of comorbidities, age > 65 years, history of bleeding ulcers, in-hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high-risk stigmata. CONCLUSION: Differences in the outcomes of nonvariceal upper gastrointestinal bleeding in clinical practice across some European countries are explained mainly by patient-related factors, and not by management factors.

Document type Article de périodique (Journal article) – Article de recherche – Journal Article, Research Support, Non-U.S. Gov't
Access type Accès restreint
Publication date 2011
Language Anglais
Journal information "Alimentary Pharmacology and Therapeutics" - Vol. 33, no. 11, p. 1225-1233 (2011)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing Ltd. ((United Kingdom) Chichester)
issn 0269-2813
e-issn 1365-2036
Publication status Publié
Affiliations UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie
UCL - (SLuc) Service d'hépato-gastro-entérologie
MESH Subject Aged ; Aged, 80 and over ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome ; Cohort Studies ; Endoscopy, Gastrointestinal - methods ; Europe - epidemiology ; Female ; Gastrointestinal Hemorrhage - epidemiology, physiopathology, therapy ; Humans ; Male ; Middle Aged
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Bibliographic reference Lanas, A ; Aabakken, L ; Fonseca, J ; Mungan, Z A ; Papatheodoridis, G V ; et. al. Clinical predictors of poor outcomes among patients with nonvariceal upper gastrointestinal bleeding in Europe. In: Alimentary Pharmacology and Therapeutics, Vol. 33, no. 11, p. 1225-1233 (2011)
Permanent URL http://hdl.handle.net/2078.1/96495