The Initial Evaluation To The Clinical Characteristics And Death Risk Of Upper Gastrointestinal Bleeding

Objective: To analyze the 1911 cases of upper gastrointestinal bleeding(UGIB), thereby summarizing the clinical characteristics and the death risk of UGIB, so as to provide a basis for improving the level of clinical diagnosis and treatment.Method: We retrospectively analyzed 1911 confirmed cases of patients who were admitted to the First Affiliated Hospital of Soochow University because of UGIB from 2011 January to 2015 December. Collecting all inpatient medical records including the patient’s general data, endoscopic findings, treatment and prognosis, preliminary analysing the clinical characteristics of UGIB in recent five years. Dividing these subjects into two groups according to the cause of bleeding: non variceal upper gastrointestinal bleeding(NVUGIB) group and esophagogastric variceal bleeding(EGVB) group, preliminary analysiing the characteristics of UGIB cases in recent 5 years. Collecting the death cases in this study, finding the death causes of UGIB and studying predictive ability of rebleeding and death to two scoring system(the Rockall’s risk score system, Child-Pugh score).Results: Ⅰ.The mean age of UGIB patients in this study is(54.47±17.04) years old, the incidence of male to female ratio was 3.04: 1.00. The mortality rate was 9.05%. Ⅱ.The top 5 etiology of UGIB were as follows: Duodenal ulcer, EGVB, gastric ulcer, gastric cancer bleeding, acute gastric mucosal lesion. Duodenal ulcer good age is less than 30 years, and with the increase of age the incidence of duodenal ulcer decreased gradually. Gastric ulcer, EGVB occur in the 50 to 69 year-old patient. Gastric cancer hemorrhage more common in 60-69 years. There was no significant difference in the incidence of acute mucosal lesions in each age group. Ⅲ.Over the past 5 years, the proportion of EGVB increased from 26.06% to 34.84%(P<0.01). The ratio of alcoholic cirrhosis bleeding increased from 3.40% to 7.48%(P<0.05), and the proportion of hepatitis B cirrhosis with hemorrhage increased from 33.19% to 42.13%(P<0.05). Ⅳ.There were significantly more patients who died of non-ulcer bleeding causes(81.58%) than bleeding causes(18.42%) in NVUGIB cases, and among those who died of non-bleeding-related causes, terminal malignancy(27.63%), pulmonary conditions(22.37%), and multiorgan failure(17.11%) were most common. In EGVB death cases, there were 38 cases(39.18%) who died of non-ulcer bleeding causes and 59(60.82%) bleeding causes. The top 3 non-ulcer bleeding causes of EGVB were as follows: hepatic encephalopathy(18.56%), multiorgan failure(14.43%), multiorgan failure(14.43%).Conclusions:Ⅰ. The main cause of UGIB is still peptic ulcer, but the proportion of EGVB increased. The proportion of alcoholic cirrhosis and hepatitis B cirrhosis increased. Ⅱ. The majority of UGIB patients died of non-bleeding-related causes. Optimization of management should aim at basic disease instead of focusing merely on successful hemostasis. Ⅲ.UGIB patients should be taken early assessment and risk stratification, to determine the risk of rebleeding and death.