Acute upper gastrointestinal bleeding: Analysis of 462 hospitalized Chinese patients in Shanghai.

Abstract

While acute upper gastrointestinal bleeding (AUGIB) remains clinically critical, the etiology of bleeding and risk factors for mortality remain uncertain. This study aimed to evaluate the underlying causes of AUGIB and identify risk factors associated with fatality. A retrospective survey was conducted in a major clinical hospital in Shanghai, where inpatients diagnosed with AUGIB were meticulously collected and analyzed. This retrospective, single-center study encompassed 462 patients diagnosed with AUGIB from the emergency department of Changhai Hospital between January 1, 2019 to November 30, 2021. The analysis involved various aspects including epidemiology, gastroscopy, imaging, laboratory tests and data, clinical features, and hospital mortality. Among the 462 patients studied, 87% (400 out of 462) were afflicted with noncirrhotic hemorrhage (up to 38% with peptic ulcer), and 4 patients required digital subtraction angiography embolization (two died). The mortality rate was 12% (49/400), of which 49% (24/49) of patients died of malignant tumors. Mortality did not differ according to sex (χ2 = 0. 851, P = .356) but was significantly influenced by age (χ2 = 18.292, P = .001), hemoglobin levels (χ2 = 22.908, P = .001), and comorbidity (χ2 = 17.355, P = .001). In patients with esophageal and gastric variceal bleeding, the mortality rate was as high as 25% (16/62). Their mortality did not vary with sex (χ2 = 0.318, P = .573), hemoglobin levels (χ2 = 4.139, P = .247), or age (χ2 = 7.674, P = .087), but was predominantly associated with hemorrhagic shock (88%, 14/16). Esophageal and gastric variceal bleeding and noncirrhotic hemorrhage patients observed significantly different mortality rates (P = .004). Peptic ulcers remained the primary cause of AUGIB. Old age, low hemoglobin levels, and comorbidities were the main risk factors contributing to mortality; nearly half of the patients died from malignant tumors. Hemorrhagic shock was independently associated with a high risk of in-hospital mortality in patients with cirrhotic hemorrhage.