Bleeding severity: defining and evaluating its role on mortality risk. A prospective multicentre cohort study

Aims Severe gastrointestinal bleeding is recognised as a risk factor for mortality but a proper definition or objective criteria to score its magnitude is lacking. Bleeding severity impacts the pre-endoscopic clinical management decision process and the timing of the endoscopy. Our aim was I) to identify independent factors contributing to the bleeding severity II) to grade its severity and III) to verify the impact of bleeding severity on mortality risk.

Methods A prospective multicentre cohort study was conducted, including all consecutive patients with upper gastrointestinal bleeding hospitalized in 50 Italian hospitals. All clinical, biochemical, and endoscopic factors influencing the bleeding severity were collected. The independent predictive factors were identified by univariate and multivariate logistic regression analysis using a backward regression analysis.

Results a total of 2.525 patients were included (mean age 68 years [±15.8], males 67.3%); bleeding source was non-variceal in 82.3%, and shock index was>1 in 7.7%. The factors most significantly associated with mortality were an altered mental status, systolic blood pressure levels, blood uric nitrogen concentration, hemoglobin levels below 8 gr/dl and hematemesis as the clinical presentation at admission. Altered mental status (AMS) and systolic blood pressure≤100mmHg are the factors with the higher odds ratio for a severe bleeding event; hematemesis, type of clinical presentation and haemoglobin (Hb) value≤8gr/dl are those with the lowest odds ratio.

Conclusions An altered mental status, systolic blood pressure≤100 mmHg, blood ureic nitrogen levels, Hb≤8gr/dl and hematemesis at admission are all independent factors implied in the bleeding severity; Patients with none of the identified risk factors have 1% death risk, with a rise-up to 45.5% for those having presented all risk factors.

Publication History

Article published online:
15 April 2024