FACTORS PREDISPOSING TO FURTHER HEMORRHAGE AND MORTALITY AFTER PEPTIC-ULCER BLEEDING

BACKGROUND: The mortality rate of peptic ulcer hemorrhage has remained unchanged, mainly attributable to rebleeding in an increasingly elder ly population. It has been advocated that early identification of pati ents at high risk of rebleeding with subsequent prompt therapy may red uce the rebleeding and mortality rates. This study examines the value of clinical factors and endoscopic findings in the prediction of furth er hemorrhage and death. STUDY DESIGN: One hundred fifty-seven patient s admitted over a two year period with bleeding from peptic ulcer were reviewed. The predictive value of individual risk factors in identify ing those patients at risk of further hemorrhage or dying was determin ed by the chi-square test with a Yates correction. RESULTS: Nineteen p atients died, 37 had further bleeding, and 31 had an early operation. Shock was the factor that best predicted further bleeding. Other signi ficant factors were a transfusion requirement of more than four units of blood during the first 48 hours and endoscopic stigmata of recent h emorrhage. The number of coexisting illnesses per patient was strongly related to fatality rate. Other factors indicative of an increased mo rtality rate included steroid use, onset of bleeding during the period of hospitalization, alcohol use, further bleeding, and a need for mor e than four units of blood transfused during the first 48 hours. CONCL USIONS: Shock remains the most valuable sign in predicting further ble eding and is superior to endoscopic stigmata. The close relationship b etween the mortality rate and coexisting illness emphasizes the fact t hat the most deaths result from nonpeptic ulcer disease.