Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study.


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Article: article from journal or magazin.
Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study.
Nahon S., Hagège H., Latrive J.P., Rosa I., Nalet B., Bour B., Faroux R., Gower P., Arpurt J.P., Denis J., Henrion J., Rémy A.J., Pariente A.
Working group(s)
Groupe des Hémorragies Digestives Hautes de l'ANGH
Abdelli N., Antoni M., Arotcarena R., Arpurt JP., Barbare JC., Barbe L., Baron P., Barre V., Bataille L., Baudet P., Becker C., Bellaiche G., Belloc J., Bellon S., Benchaa BA., Benhalima M., Benoit R., Bernard P., Bernardini D., Berthelemy P., Berthelet O., Bicheler V., Blanchi A., Bohon P., Bonnefoy B., Borgeot C., Boruchowicz A., Bottlaender J., Boulay G., Bour B., Bouret JF., Bourhis F., Boutet O., Bouvier J., Boyaval JM., Bramli S., Bremond C., Bresson S., Bretagnolle P., Breysacher G., Brihier H., Butel J., Canva JY., Cassan P., Casteuble D., Charlois T., Chayette C., Cheaib S., Chiappa P., Chinoune F., Cocq-Vezilier P., Colmard P., Combes R., Coquard JL., Costentin L., Coulibaly B., D'Abrigeon G., Danisi C., Danne O., Dartois-Hoguin M., Davion T., De Maeght S., de Montighy-Lenhardt S., Delas N., Delatre-Becuwe C., Delhoustal L., Deltenre P., Delvert D., Denis J., Denis B., Desseaux G., Diab G., Djedir R., Doumet S., Duburque C., Duchmann JC., Duffournet V., Dufilhol C., El Braks R., Escudie L., Faroux R., Flamenbaum M., Fleury A., Foutrein MC., Gamblin C., Gayno S., Geagea E., Ghilain JM., Gillot D., Glibert A., Goegebeur G., Gower P., Grasset D., Groleau GS., Guillemot F., Gury B., Hagege H., Haioun IN., Heluwaert F., Henrion J., Henriou HP., Imani K., Janicki E., Jego M., Jomri KM., Kerjean A., Khalfoun A., Labayle D., Laberenne JE., Lacherade JC., Lafargue JP., Lagarrigue C., Lambare B., Latrive JP., Laty G., Le Bris M., Le Corguille, Le Dreau G., Le Verger JC. , Lemaire E., Leroy-Doucy M., Lesgourgues B., Ley G., Listrat D., Lons T., Loury-Lariviere I., Macaigne G., Magois-Pilon K., Maisin M., Manet-Lacombe S., Marcato N., Marks-Brunel B., Martin Messerschmitt C., Medinger G., Messikh G., Monat S., Morin T., Moulart M., Nahon S., Nalet B., Nouel O., Osman H., Ouraghi A., Ozenne V., Pariente A., Paupard T., Pauwels A., Payen JL., Peter A., Picon-Coste M., Pileire G., Pilette C., Pillon D., Prost P., Puech P., Pugelier QG., Quoic RI., Radia Pakatovao J., Ramadan I., Rambaud S., Ramgoolam B., Ratajczyk S., Remy AJ., Richez C., Rierajc , Rocher P., Rosa I., Rossi V., Schapira M., Schnee M., Scribe-Outas M., Seyrig JA., Shekh Al Shabab N., Slama JL., Soupison A., Tennenbaum R., Tielman G., Tissot B., Tordjman G., Touze I., Vitte RL., Wantiez M., Weiss AM., Wisniewski B., Zavadil P.
1438-8812 (Electronic)
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Issued date
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
BACKGROUND AND STUDY AIMS: The mortality rate from upper gastrointestinal bleeding (UGIB) remains high, at 5 % - 10 %. The aim of the current study was to describe the epidemiological characteristics, prognostic factors, and actual practice in a cohort of patients with UGIB admitted to French general hospitals.
METHODS: From March 2005 to February 2006, a prospective multicenter study was conducted at 53 French hospitals. A total of 3298 patients admitted for UGIB were enrolled consecutively. Patient data were collected up to the date of discharge from hospital.
RESULTS: Data were available for 2130 men and 1073 women (mean age 63 ± 18 years), one-third of whom were taking drugs that would increase the risk of UGIB. The two main causes of bleeding were peptic ulcers (38 %) and esophagogastric varices (EGV) or portal hypertensive gastropathy (24.5 %). Mean Rockall score was 5.0 ± 2.3. Endoscopy was performed on 96 % of patients (within 24 hours in 79 %), and 66 % of those with ulcers and 62.5 % of the EGV patients underwent hemostatic therapy when indicated. Rebleeding occurred in 9.9 % of the patients, and 8.3 % died. Independent predictors of rebleeding were: need for transfusion (odds ratio [OR] 19.1; 95 % confidence interval [95 %CI] 10.1 - 35.9); hemoglobin < 10 g/dL (OR: 1.7; 95 %CI 1.1 - 3.3); Rockall score (OR: 1.4 for each 1 point score increase; 95 %CI 1.0 - 1.9), systolic blood pressure < 100 mmHg (OR: 1.9; 95 %CI 1.4 - 2.5), and signs of recent bleeding (OR: 2.4; 95 %CI 1.7 - 3.5). Independent predictors of mortality were: Rockall score (OR: 2.8; 95 %CI 2.0 - 4.0), co-morbidities (OR: 3.6 for each additional co-morbidity; 95 %CI 2.0 - 6.3), and systolic blood pressure < 100 mmHg (OR: 2.1; 95 %CI 1.8 - 2.8). Rockall score, blood pressure and co-morbidities were taken as continuous variables meaning that the OR was 1.4 for every point increase, it was the same for blood pressure.
CONCLUSION: UGIB still occurs mainly as a result of peptic ulcers and portal hypertension in France, and causes significant rates of mortality. There is scope for improvement via better prevention (better use of UGIB-facilitating drugs), endoscopic therapy, and management of co-morbidities.
Aged, Endoscopy, Female, France/epidemiology, Gastrointestinal Hemorrhage/epidemiology, Gastrointestinal Hemorrhage/etiology, Helicobacter Infections/complications, Helicobacter pylori, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Treatment Outcome
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06/12/2013 10:03
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20/08/2019 15:33
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