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Distinct Clinical and Outcome Profiles Across Six Subtypes of Acute Gastrointestinal Bleeding: A Comprehensive
Nóra Vörhendi1, Levente Frim1, Orsolya Anna Simon1,2
1Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pecs, Hungary.
Insights
Acute gastrointestinal bleeding (GIB) varies significantly by subtype. Variceal bleeding presents the worst outcomes, while iatrogenic GIB shows a favorable course, highlighting the need for tailored management strategies.
Area of Science:
- Gastroenterology and Hepatology
- Clinical Medicine
- Epidemiology
Background:
- Acute gastrointestinal bleeding (GIB) is a critical medical emergency with significant morbidity, mortality, and healthcare costs.
- Previous studies have underrepresented specific GIB subtypes, such as iatrogenic bleeding, necessitating comprehensive characterization.
Purpose of the Study:
- To comprehensively characterize all subtypes of overt gastrointestinal bleeding (GIB).
- To compare clinical outcomes across different GIB subtypes, including iatrogenic causes.
- To inform subtype-specific clinical management strategies for GIB.
Main Methods:
- An ambidirectional cohort study involving 1021 adult patients with overt GIB from two Hungarian tertiary centers.
- Standardized data collection on demographics, comorbidities, medications, bleeding source, and in-hospital outcomes (mortality, rebleeding, ICU admission, LoH, interventions).
- Statistical comparisons and survival analysis using Kaplan-Meier curves.
Main Results:
- Non-variceal upper GIB was most common (51.0%), followed by lower GIB (29.7%), variceal GIB (8.9%), and iatrogenic GIB (7.5%).
- Overall in-hospital mortality was 10.6%, with the highest rates in variceal bleeding (22%).
- Intraprocedural iatrogenic bleeding showed a significantly shorter length of hospitalization compared to other subtypes.
Conclusions:
- Gastrointestinal bleeding is a heterogeneous condition with distinct outcome profiles for each subtype.
- Variceal bleeding is associated with the poorest outcomes, whereas intraprocedural iatrogenic bleeding has a favorable prognosis.
- Findings support the need for subtype-specific clinical management of GIB and validation in larger cohorts.
Abstract:
Background: Acute gastrointestinal bleeding (GIB) remains a major clinical emergency with substantial morbidity, mortality, and healthcare burden. We aimed to provide a comprehensive characterization of all GIB subtypes, including iatrogenic bleeding, which is underrepresented in previous studies. Methods: In this ambidirectional cohort study, 1021 consecutive adults with overt GIB were enrolled from two Hungarian tertiary centers. Standardized data collection included demographics, comorbidities, medication use, bleeding source, and in-hospital outcomes: mortality, rebleeding, intensive care unit (ICU) admission, length of hospitalization (LoH), endoscopic evaluation and haemostatic intervention, red blood cell transfusion, and surgical intervention. Group comparisons were performed using appropriate statistical tests, and survival was analysed using Kaplan-Meier curves (R v4.4.2; p < 0.05). Results: Non-variceal upper GIB was the most common subtype (51.0%), followed by lower GIB (29.7%), variceal GIB (8.9%), small bowel bleeding (2.3%), and iatrogenic bleeding (7.5%). Overall, in-hospital mortality was 10.6%, highest in variceal bleeding (22%). Rebleeding occurred in 5.3% of cases, most frequently in variceal bleeding. ICU admission was required in 8.9% of patients, again, most common in variceal bleeding (21.6%). The median LoH was 7 days (IQR 4-10), significantly shorter in cases of intraprocedural iatrogenic bleeding. Endoscopy was performed in 91% of cases, with haemostatic intervention in 57%. Surgery was required in 3.4% of patients. Conclusions: Gastrointestinal bleeding represents a heterogeneous clinical entity with distinct outcome profiles across subtypes. Variceal bleeding was associated with the most unfavorable outcomes, whereas intraprocedural iatrogenic bleeding had a favorable course. These findings support subtype-specific clinical management and warrant validation in larger multicenter cohorts.
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