Predictors of Mortality in End-stage Renal Disease Patients Presenting with Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding (UGIB) is a life-threatening medical condition. Patients with end-stage renal disease (ESRD) are at an increased risk of bleeding and mortality. The etiology of UGIB in ESRD patients includes peptic ulcer disease, angiodysplasia, and the administration of anticoagulants. Therefore, we aimed to identify the factors predicting mortality in ESRD patients presenting with UGIB.

This prospective cohort study was carried out at the department of hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), from February 2022 to December 2023. For this study, 209 patients with ESRD on hemodialysis presenting with symptoms of NVUGIB were enrolled. Vital signs, laboratory parameters, and endoscopic findings were noted. The outcome was measured in terms of 1-month mortality. Univariate followed by multivariate logistic regression analysis was performed to identify the independent predictors of mortality in the ESRD population presenting with upper GI bleeding.

Out of 209 subjects, 92 died within 1 month. On multivariate analysis, diagnosis of diabetes was significant at p = 0.01, odds ratio (OR): 4.6; hypotension, p = 0.001, OR: 2.37; tachycardia, p ≤ 0.001, OR: 1.7; Forrest class Ia ulcers, p ≤ 0.001, OR: 7.14; increased International Normalized Ratio (INR), p = 0.009, OR: 1.2; low platelet count, p = 0.002, OR: 1.9; and dual endoscopic therapy need, p ≤ 0.001, OR: 44.9.

This study has underlined that diabetes, hemodynamic instability, certain endoscopic findings, and the need for dual therapy are significant predictors of mortality in ESRD patients with UGIB. Aggressive management of such factors, if possible with early identification, significantly improves the outcome in this high-risk population.