Non-variceal upper GI bleeding in patients already hospitalized for another condition

To compare outpatients (OPs) presenting with non-variceal upper gastrointestinal bleeding (NVUGIB) to those who started hemorrhaging while in a hospital (inpatients, IPs) in a contemporary setting and to better identify predictors of outcome.

Retrospective data from the Canadian Registry of Patients With Upper Gastrointestinal Bleeding Undergoing Endoscopy (RUGBE). Descriptive, inferential, and multivariate logistic regression models were carried out in 469 IPs (68.5+/-14 years, 36% women) and 1,395 OPs (65.5+/-18 years, 39% women) in 18 Canadian community and tertiary care centers.

Main outcomes were rebleeding, mortality, and their predictors. IPs differed from OPs in disease acuity (P=0.02) and comorbidities (3.1+/-1.7 vs. 2.3+/-1.5, P<0.001), and were admitted longer (7.2+/-7.4 vs. 5+/-5.4 days, P<0.001) and more often to intensive care unit (ICU; 40.5% vs. 16%, P<0.001). Ulcers or erosions predominated (83% vs. 85%, P=0.28), treated by endotherapy (38% vs. 36%, P=0.46). More IPs received proton pump inhibitors (PPIs; 88% vs. 83%, P=0.009). Mortality was greater for IPs (11% vs. 3.5%, P<0.001), but rebleeding (15.7% vs. 13.4%, P=0.23) and surgery (6.9% vs. 6.4%, P=0.72) were not. Among IPs, comorbidity (odds ratio, OR=1.15; 95% confidence interval, CI: 1.01-1.32) and endoscopic high-risk stigmata increased (OR=3.86, 95% CI:2.05-7.26), whereas PPI decreased (OR=0.20, 95% CI:0.10-0.42) rebleeding; high-risk stigmata (OR=3.13, 95% CI:1.23-7.99) and rebleeding (OR=4.19, 95% CI:2.06-8.55) increased mortality, whereas low disease acuity was protective (OR=0.20; 95% CI:0.46-0.90).

IPs are sicker than OPs. Endoscopic hemostasis and PPI therapy favorably affect rebleeding in IPs, whereas patient characteristics principally determine the threefold greater IPs mortality.