Factors predisposing to further hemorrhage and mortality after peptic ulcer bleeding

The mortality rate of peptic ulcer hemorrhage has remained unchanged, mainly attributable to rebleeding in an increasingly elderly population. It has been advocated that early identification of patients at high risk of rebleeding with subsequent prompt therapy may reduce the rebleeding and mortality rates. This study examines the value of clinical factors and endoscopic findings in the prediction of further hemorrhage and death.

One hundred fifty-seven patients admitted over a two year period with bleeding from peptic ulcer were reviewed. The predictive value of individual risk factors in identifying those patients at risk of further hemorrhage or dying was determined by the chi-square test with a Yates correction.

Nineteen patients died, 37 had further bleeding, and 31 had an early operation. Shock was the factor that best predicted further bleeding. Other significant factors were a transfusion requirement of more than four units of blood during the first 48 hours and endoscopic stigmata of recent hemorrhage. The number of coexisting illnesses per patient was strongly related to fatality rate. Other factors indicative of an increased mortality rate included steroid use, onset of bleeding during the period of hospitalization, alcohol use, further bleeding, and a need for more than four units of blood transfused during the first 48 hours.

Shock remains the most valuable sign in predicting further bleeding and is superior to endoscopic stigmata. The close relationship between the mortality rate and coexisting illness emphasizes the fact that the most deaths result from nonpeptic ulcer disease.