Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial.

Autor: Quentin V; Department of Gastroenterology, Centre Hospitalier (CH) de Saint-Brieuc, Saint-Brieuc, France., Remy AJ; Department of Gastroenterology, CH de Perpignan, Perpignan, France., Macaigne G; Department of Gastroenterology, CH de Marne-la-Vallée, Marne-la-Vallée, France., Leblanc-Boubchir R; Department of Gastroenterology, CH de Valenciennes, Valenciennes, France., Arpurt JP; Department of Gastroenterology, CH d'Avignon, Avignon, France., Prieto M; Department of Gastroenterology, CH de Meaux, Meaux, France., Koudougou C; Department of Gastroenterology, CH de La Roche-sur-Yon, La Roche-sur-Yon, France., Tsakiris L; Department of Gastroenterology, CH de Melun, Melun, France., Grasset D; Department of Gastroenterology, CH de Vannes, Vannes, France., Vitte RL; Department of Gastroenterology, CH de Poissy, Poissy, France., Cuen D; Department of Gastroenterology, CH de Saint-Malo, Saint-Malo, France., Verlynde J; Department of Gastroenterology, CH de Dunkerque, Dunkerque, France., Elriz K; Department of Gastroenterology, CH de Corbeil, Corbeil, France., Ripault MP; Department of Gastroenterology, CH de Béziers, Béziers, France., Ehrhard F; Department of Gastroenterology, CH de Lorient, Lorient, France., Baconnier M; Department of Gastroenterology, CH d'Annecy, Annecy, France., Herrmann S; Department of Gastroenterology, CH d'Orléans, Orléans, France., Talbodec N; Department of Gastroenterology, CH de Tourcoing, Tourcoing, France., Lam YH; Department of Gastroenterology, CH de Cholet, Cholet, France., Bideau K; Department of Gastroenterology, CH de Quimper, Quimper, France., Costes L; Department of Gastroenterology, CH de Créteil, Créteil, France., Skinazi F; Department of Gastroenterology, CH de Saint-Denis, Saint-Denis, France., Touze I; Department of Gastroenterology, CH de Lens, Lens, France., Heresbach D; Department of Gastroenterology, CH de Pontivy, Pontivy, France., Lahmek P; Department of Gastroenterology, CH de Limeil-Brévannes, Limeil-Brévannes, France., Nahon S; Department of Gastroenterology, CH de Montfermeil, Montfermeil, France.
Jazyk: angličtina
Zdroj: Endoscopy international open [Endosc Int Open] 2021 Sep 16; Vol. 9 (10), pp. E1504-E1511. Date of Electronic Publication: 2021 Sep 16 (Print Publication: 2021).
DOI: 10.1055/a-1508-5871
Abstrakt: Background and study aims  Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods  Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results  Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1-4) and Rockall score was 5 (IQR 3-6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04-2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31-2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39-2.80), being an inpatient (OR 2.45; 95 %CI 1.76-3.41) and rebleeding (OR 2.6; 95 %CI 1.85-3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions  The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.
Competing Interests: Competing interests Dr. Nahon has received lecture fees from MSD, Takeda and Sandoz, and consulting fees from MSD, Takeda, Janssen, Sandoz, Ferring, and Vifor. Dr. Arotcarena has received funds from Gilead and Abbvie to attend meetings. Dr. Macaigne has received funding from Jansen, Takeda, Abbvie, and Tillots to attend meetings.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze: MEDLINE
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