Risk factors for rebleeding and mortality from acute upper gastrointestinal hemorrhage in human immunodeficiency virus infection

Objectives: In the general population, acute upper gastrointestinal hemorrh age (UGIH) is a common problem that results in significant morbidity and mo rtality. The aim of this study was to determine the etiology, clinical outc ome, and risk factors for rebleeding and mortality in a large cohort of hum an immunodeficiency virus (HIV)-infected patients with acute UGIH. Methods: We reviewed the medical records of consecutive HIV-infected patients with acute UGIH who were referred for an endoscopic evaluation from January 1992 through January 1997 at Bellevue Hospital Center. Results: During the 5-yr study period, 297 HIV-infected patients with acute UGIH were evaluated by endoscopy. Gastroduodenal ulcers (25.6%), esophageal ulcers (21.5%), and Ka posi's sarcoma (19.2%) were the three most common causes of acute UGIH. Fif teen percent of patients rebled within 30 days and independent predictors o f rebleeding included a CD4 count of <200 cells/ mm(3), inpatient status, a hemoglobin of <8 g/dl, major stigmata of hemorrhage, and lymphoma. The 30- day mortality from UGIH was 11.4% and a hemoglobin of <8 g/dl, a platelet c ount of <100,000/mm(3), major stigmata of hemorrhage, rebleeding within 30 days, and lymphoma were independent predictors of mortality. The introducti on of protease inhibitors in December 1995 resulted in a reduction in 30-da y mortality from 13.5% to 4.4% (p = 0.04) without affecting the etiology of UGIH or the incidence of rebleeding. Conclusions: Acute UGIH in HIV-infect ed patients is most commonly due to gastroduodenal ulcers, esophageal ulcer s, and Kaposi's sarcoma. In this patient population, the introduction of pr otease inhibitors has had a positive impact on the outcome of UGIH. (Am J G astroenterol 1999;94: 358-363. (C) 1999 by Am. Cell. of Gastroenterology).