Non-Variceal Upper GI Bleeding in Patients Already Hospitalized for Another Condition

OBJECTIVES: To compare outpatients (OPs) presenting with non-variceal upper gastrointestinal bleeding (NVUGIB) to those who started hemorrhaging while in a hospital (inpatients, IPs) in a contemporary setting and to better identify predictors of outcome. METHODS: Retrospective data from the Canadian Registry of Patients With Upper Gastrointestinal Bleeding Undergoing Endoscopy (RUGBE). Descriptive, inferential, and multivariate logistic regression models were carried out in 469 IPs (68.5 +/- 14 years, 36 % women) and 1,395 OPs (65.5 +/- 18 years, 39 % women) in 18 Canadian community and tertiary care centers. RESULTS: Main outcomes were rebleeding, mortality, and their predictors. IPs differed from OPs in disease acuity (P = 0.02) and comorbidities (3.1 +/- 1.7 vs. 2.3 +/- 1.5, P < 0.001), and were admitted longer (7.2 +/- 7.4 vs. 5 +/- 5.4 days, P < 0.001) and more often to intensive care unit (ICU; 40.5 % vs. 16 %, P < 0.001). Ulcers or erosions predominated (83 % vs. 85 %, P = 0.28), treated by endotherapy (38 % vs. 36 %, P = 0.46). More IPs received proton pump inhibitors (PPIs; 88 % vs. 83 %, P = 0.009). Mortality was greater for IPs (11 % vs. 3.5%, P < 0.001), but rebleeding (15.7% vs. 13.4%, P = 0.23) and surgery (6.9% vs. 6.4%, P = 0.72) were not. Among IPs, comorbidity (odds ratio, OR = 1.15; 95 % confidence interval, CI: 1.01-1.32) and endoscopic high-risk stigmata increased (OR = 3.86, 95 % CI: 2.05-7.26), whereas PPI decreased (OR = 0.20, 95 % CI: 0.10-0.42) rebleeding; high-risk stigmata (OR = 3.13, 95 % CI: 1.23-7.99) and rebleeding (OR = 4.19, 95 % CI: 2.06-8.55) increased mortality, whereas low disease acuity was protective (OR = 0.20; 95 % CI: 0.46-0.90). CONCLUSIONS: IPs are sicker than OPs. Endoscopic hemostasis and PPI therapy favorably affect rebleeding in IPs, whereas patient characteristics principally determine the threefold greater IPs