Assessment of Mortality and Causes after Re-bleed In Patients Having Endoscopy for Upper Gastrointestinal Bleeding

Abstract

Introduction: Acute Upper gastrointestinal bleeding (AUGIB), with prevalence of 36 to 172/100,000 natives per year, is a common medical emergency. Mortality rate after UGIB ranges from 4–14% while re-bleeding is evident in 10–30% of these patients. Despite advances in treatment modalities of UGIB, the in-hospital mortality rate remains high and it is commonly due to re-bleeding. However, the causes and frequency of mortality among patients with re-bleeding are not well known in Pakistan.

Objective: To determine the frequency and causes of in-hospital mortality after re-bleeding among patients undergoing endoscopy for upper gastrointestinal bleeding.

Methodology:  A descriptive cross-sectional study was done in Military hospital Rawalpindi from December 2014 to June 2015. A total 150 patients aged between 18 to 65 years who presented with upper gastrointestinal bleeding (UGIB) and underwent upper GI endoscopy and re-bleed were included through purposive sampling. Structured questionnaire used to record data. The patients were observed for mortality and causes after re-bleeding in the hospital for about 5 days. Patients who died, the cause of the death was assessed by 2 senior consultant physicians. SPSS version 21 was used for data entry and analysis. Variables like mortality were presented as percentage and frequencies. Effect modifiers like age and gender were controlled by stratification.

Results:  The mean age of patients (n=150) was 43.97±12.28 years. Among total cases, 97 (64.7%) were males and 53 (35.7%) were females. The in-hospital mortality rate was 20% (n=30), re-bleed was cause in 12 (40%) while in 18 (60%) cause was other than re-bleed (cardiac, multi-organ failure, neurological, pulmonary, and advanced malignancy). Mortality in male patients was higher (n=18, 60.0%) as compared to female patients (n=12, 40.0%). The highest mortality (n=22, 73.3%) was observed in age group ˃43 years. The association of in-hospital mortality was statistically significant (p value = 0.02) by age but not by gender.

Conclusion: In-hospital mortality after UGIB is 20 %, frequent cause is other than the re-bleed. Male above aged 43 are more vulnerable. Management of UGIB should also focus on optimization of non-re-bleeding causes and other co-morbid related deaths instead of merely maintaining homeostasis and blood transfusions.

Keywords: Re-bleeding, Mortality, Acute Upper Gastrointestinal Bleeding, Upper GI Endoscopy.