Risk of 30-day all-cause mortality in octogenarians with non-variceal upper gastrointestinal bleeding: a multinational analysis.

Abstract

Background: Studies show declining non-variceal upper gastrointestinal bleeding (NVUGIB) incidence and hospitalization, likely due to novel pharmacological and endoscopic therapies. However, data on mortality and outcomes in octogenarians with NVUGIB remain limited.

Methods: We conducted a retrospective cohort study using the TriNetX platform, identifying adults NVUGIB between January 1, 2014, and May 18, 2025. Patients with gastroesophageal variceal bleeding were excluded. Two age cohorts (> 80 years and 18-65 years) were 1:1 propensity matched according to sex, demographics, comorbidities, and medications. The primary outcome was risk of all-cause mortality. Secondary outcomes included in-hospital and procedure-related outcomes. Cox-proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (CIs).

Results: 117,695 octogenarians (mean [SD] age, 81.4 [5.3] year; 59,524 [50.6%] female) were matched with 117,695 patients < 65 years (mean [SD] age, 44.9 [13.6] year; 60,044 [51.0%] female). The octogenarian cohort had significantly higher all-cause mortality (HR, 2.73; 95% CI 2.60-2.87), acute kidney injury (HR, 1.61; 95% CI 1.56-1.66), mechanical ventilation (HR, 1.17; 95% CI 1.12-1.23), hypovolemic shock (HR, 1.54; 95% CI 1.40-1.70), and intensive care unit admission (HR, 1.10; 95% CI 1.06-1.13) compared to those aged under 65 years. Subgroup analysis comparing the timing of endoscopy and its effect on mortality showed increased all-cause mortality in octogenarians with NVUGIB and early endoscopy (HR, 2.04; 95% CI 1.81-2.30).

Conclusion: Through this multicenter retrospective study, we demonstrate that octogenarians with NVUGIB have a 2.7-fold higher risk of all-cause mortality. This study emphasizes the importance of early diagnosis, aggressive management, and risk stratification to improve outcomes in this population.