RISK-FACTORS FOR PERSISTANT OR RECURRENT HEMORRHAGE AND MORTALITY OF BLEEDING PEPTIC-ULCERS

The mortality rate of peptic ulcer haemorrhage has remained unchanged, mainly attributed to rebleeding in an increasingly elder population w ith more coexisting systemic diseases. The value of clinical factors a nd endoscopic findings in predicting in-hospital further haemorrhage a nd death are analysed. Over a 2-year period, 157 consecutive patients were admitted with bleeding from peptic ulcer, 19 died and 37 had furt her bleeding. The predictive value of each factor was determined by th e chi2 test with a Yates-correction (significant, p <0.05). Significan t predictive factors of further bleeding were shock, a transfusion req uirement >4 units during the first 48 hours and endoscopic stigmata of recent haemorrhage. The combination of these factors was not of bette r predictive value than shock alone. The number of coexisting illnesse s per patient was strongly related to fatality rate. Other significant factors indicative of an increased mortality included steroid, onset of bleeding during a hospital stay, alcohol, further bleeding, and >4 units transfused over the first 48 hours. Shock remains the most valua ble sign in predicting further bleeding and is superior to endoscopic stigmata. The close relationship between the mortality rate and coexis ting illnesses underlines the fact that the majority of deaths result from non peptic ulcer disease.