RESUMEN
OBJECTIVE: To describe the experience with upper gastrointestinal bleeding in two major Latin American hospitals; presenting its main causes, treatment, and prognosis, while exploring some risk factors associated with death. DESIGN: Prospective cohort study. PATIENTS AND METHODS: Four hundred and sixty four patients were admitted into any of the 2 hospitals and were at least 15 years of age. Some variables demographics, clinics and treatment were studied. The association between those variables and the death were explored. RESULTS: Mean age was 57.9 years; the men:women ratio was 1.4:1. Three hundred and fifty nine patients (77.3%) presented as outpatients and 105 patients (22.6%) were inpatients presenting with UGIB. 71.6% of patients had an upper GI endoscopy within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 41%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty four patients died (9.5%). Bleeding as an inpatient has a higher mortality risk than does bleeding as an outpatient (RR 2.4 IC 95% 1.2-4.6). An increasing number of comorbidities such as those described in the Rockall Score are also associated with a higher risk of dying (RR 2.5 IC 95% 1.1-5.4). CONCLUSION: UGIB as an inpatient and the presence of comorbidities should alert the clinician in identifying patients at higher risk of a fatal outcome, these patients should have a more aggressive management and be entitled to an early intervention.
Asunto(s)
Várices Esofágicas y Gástricas/mortalidad , Hemorragia Gastrointestinal/mortalidad , Adulto , Anciano , Anticoagulantes/efectos adversos , Colombia/epidemiología , Comorbilidad , Úlcera Duodenal/mortalidad , Embolización Terapéutica , Endoscopía del Sistema Digestivo , Esofagitis/complicaciones , Esofagitis/mortalidad , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hospitales Generales/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Úlcera Péptica Hemorrágica/mortalidad , Estudios Prospectivos , Factores de Riesgo , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/mortalidad , Úlcera Gástrica/mortalidadRESUMEN
Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA) en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se incluyeron 464 pacientes mayores de 15 años de dos centros de referencia. Se estudiaron algunas variables demográficas, antecedentes, presentación clínica, tratamiento y mortalidad. Se exploraron las asociaciones de estas variables con el desenlace muerte. Resultados: el promedio de edad fue de 57,9 años, la proporción hombre: mujer fue de 1,4:1. Trescientos cincuenta y nueve pacientes (77,3%) consultaron a causa de sangrado digestivo (sangrado extrahospitalario) y 105 pacientes (22,6%) lo presen - taron en la institución (sangrado intrahospitalario). A un 71,6% de los pacientes que ingresaron con el diagnóstico de HDA se les rea lizó endoscopia digestiva alta (EDA) en las primeras 24 horas. Las causas de sangrado más frecuentes fueron úlcera péptica en 190 pacientes (41%), enfermedad erosiva en 162 (34,9%) y enfermedad variceal 47 (10,1%). La mortalidad fue del 9,5%. Los pacientes que presentan sangrado durante una hospitalización por otra causa, presentaron un riesgo de morir mayor que los pacientes cuyo motivo de consulta fue el sangrado digestivo (RR 2,4 IC 95% 1,2-4,6). La presencia de comobilidades expresada por el valor ascendente asignado por la clasificación de Rockall está asociado igualmente con mayor probabilidad de muerte (RR 2,5 IC 95% 1,1-5,4). Conclusión: el sangrado digestivo intrahospitalario y la presencia de comorbilidades son factores de riesgo para presentar un desenlace fatal. Identificar los pacientes de mayor riesgo contribuiría a mejorar el manejo de los pacientes con HDA(AU)
Objective: to describe the experience with upper gastrointestinal bleeding in two major Latin American hospitals; presenting its main causes, treatment, and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: four hundred and sixty four patients were admitted into any of the 2 hospitals and were at least 15 years of age. Some variables demographics, clinics and treatment were studied. The association between those variables and the death were explored. Results: mean age was 57.9 years; the men:women ratio was 1.4:1. Three hundred and fifty nine patients (77.3%) presented as outpatients and 105 patients (22.6%) were inpatients presenting with UGIB. 71.6% of patients had an upper GI endoscopy within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 41%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty four patients died (9.5%). Bleeding as an inpatient has a higher mortality risk than does bleeding as an outpatient (RR 2.4 IC 95% 1.2-4.6). An increasing number of comorbidities such as those described in the Rockall Score are also associated with a higher risk of dying (RR 2.5 IC 95% 1.1-5.4). Conclusion: UGIB as an inpatient and the presence of comorbidities should alert the clinician in identifying patients at higher risk of a fatal outcome, these patients should have a more aggressive management and be entitled to an early intervention(AU)