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 elderly patients despite therapeutic advances. Little is known about what actually determines rebleeding and mortality. The objective of this study 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, hospitalized due to an endoscopically verified acute PUB were included in the study (n = 508). Interventions The occurrence of rebleeding within 3 days and mortality within 30 days was registered for all patients. A predefined set of variables with a potential to influence rebleeding and mortality was analysed in a multiple logistic regression model. Main outcome measures Odds ratios (with confidence intervals) for all predefined variables with respect to influence upon rebleeding and mortality, respectively. Results The risk of rebleeding was significantly increased with greater age and if the patient was suffering from shock, while omeprazole infusion, acetylsalicylic acid (ASA)/non-steroidal anti-inflammatory drug (NSAID) intake before admission and gastric ulcer localization were associated with a lower risk Mortality was significantly increased with greater age, heart disease and blood pressure < 100 mmHg at admission. Previous ulcer history and the presence of a Forrest class IIa ulcer significantly reduced this risk. Conclusions Elderly patients in shock admitted due to their first peptic ulcer bleeding run the greatest risk of an unfavourable outcome. (C) 1998 Lippincott Williams & Wilkins.