RISK-FACTORS FOR REBLEEDING AND FATAL OUTCOME IN ELDERLY PATIENTS WITH ACUTE PEPTIC-ULCER BLEEDING

Objective Mortality after peptic ulcer bleeding (PUB) is high in elder ly patients despite therapeutic advances. Little is known about what a ctually determines rebleeding and mortality. The objective of this stu dy was to investigate which factors may have an independent influence upon rebleeding and mortality in patients with PUB. Design Prospective cohort study. Participants Patients, above 60 years of age, hospitali zed due to an endoscopically verified acute PUB were included in the s tudy (n = 508). Interventions The occurrence of rebleeding within 3 da ys and mortality within 30 days was registered for all patients. A pre defined set of variables with a potential to influence rebleeding and mortality was analysed in a multiple logistic regression model. Main o utcome measures Odds ratios (with confidence intervals) for all predef ined variables with respect to influence upon rebleeding and mortality , respectively. Results The risk of rebleeding was significantly incre ased with greater age and if the patient was suffering from shock, whi le omeprazole infusion, acetylsalicylic acid (ASA)/non-steroidal anti- inflammatory drug (NSAID) intake before admission and gastric ulcer lo calization were associated with a lower risk Mortality was significant ly increased with greater age, heart disease and blood pressure < 100 mmHg at admission. Previous ulcer history and the presence of a Forres t class IIa ulcer significantly reduced this risk. Conclusions Elderly patients in shock admitted due to their first peptic ulcer bleeding r un the greatest risk of an unfavourable outcome. (C) 1998 Lippincott W illiams & Wilkins.