Prospective multicenter study of prognostic factors in peptic ulcer bleeding. Reassessment of clinical and endoscopic data at the era of endoscopic hemostasis

Aim - To evaluate in a prospective study the prognostic factors of recurren t bleeding and mortality in patients presenting with high risk peptic ulcer bleeding routinely treated by endoscopic hemostasis. Patients and methods - A multicenter study was carried out in 8 Western Fre nch hospitals in 144 patients with gastrointestinal bleeding peptic from ul cer type I or IIa, b as defined by Forrest classification. Thirty four and 38 parameters were studied respectively in order to predict recurrent bleed ing and death. Significant predictive factors (P < 0.1) in univariate analy sis were entered in a multivariate logistic regression analysis. Results - Endoscopic hemostasis was performed in 108 of 144 cases (75%) Rec urrent bleeding and death occurred in 39 (28%) and 22 cases (15%) respectiv ely. By multivariate analysis, the only predictor of rebleeding was hypovol emia at admission. Predictors of death were ASA score, cardiovascular Goldm an score and recurrent bleeding. In this study, prevalence of Helicobacter pylori infection was low (41%) but was not a predictive factor Conclusions - In a selected population of peptic ulcer bleeding patients wi th high risk of rebleeding, prevalence of recurrent bleeding and dec;th rem ains rather high; despite routine endoscopic hemostasis. In the era of endo scopic hemostasis, clinical parameters remain the best prognostic factors o f peptic ulcer bleeding outcome.