In-Hospital Mortality Risk Estimation in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding Undergoing Hemodialysis: A Retrospective Cohort Study

Figures & data

Figure 1.  Study flow of the uremia cohort with UGIB.

Figure 2.  Cumulative incidence of all-cause mortality during hospitalization.

Table 1.  Baseline characteristics of patients with UGIB in the uremia group.

	UGIB
	(n = 322)
	Survival (n = 232)	Mortality (n = 90)
	n (%)	n (%)	p^a
Age (y), mean ± SD	69.5 ± 14.3	73.0 ± 13.2	0.044
Gender
Male	91 (39.2)	42 (46.7)	0.257
Female	141 (60.8)	48 (53.3)
Length of hospital stay
≤14 days	116 (50.0)	27 (30.0)	0.001
>14 days	116 (50.0)	63 (70.0)
Infection during hospitalization	82 (35.3)	59 (65.6)	<0.001
UGIB
Single episode	168 (72.4)	76 (84.4)	0.029
Recurrent	48 (27.6)	14 (15.6)
Hepatitis
B, C, B + C	58 (25.0)	24 (26.7)	0.869
Non-B and non-C	174 (75.0)	66 (73.3)
HTN	120 (51.7)	29 (32.2)	0.002
CV disease	69 (29.9)	25 (27.8)	0.815
Type 2 DM	40 (17.2)	5 (5.6)	0.011
Chronic disease number ≥3^c	123 (53.0)	39 (43.3)	0.151
Cancer	20 (8.6)	8 (8.9)	1.000
Duration of follow-up [months; median (IQR)]	6.40 (1.51–21.35)	1.00 (0.40–1.58)	<0.001^b

Notes: UGIB, upper gastrointestinal bleeding; HTN, hypertension; CV disease, cardiovascular disease; DM, diabetes mellitus; IQR, interquartile range.

^aCalculated by chi-square test.

^bCalculated by Mann–Whitney U test.

^cWithin 19 evaluated chronic diseases, including chronic arthritis, autoimmune diseases, hypertension, diabetes mellitus, chronic heart disease, stroke, dyslipidemia, hyperuricemia, chronic obstructive pulmonary disease, asthma, mycobacterium tuberculosis, hepatitis, peptic ulcer, hemorrhoid, benign prostate hypertrophy, cancer, varicosis, vertebral degenerative joint disease, and osteoarthritis

Table 2.  Laboratory data of patients with UGIB in the uremia group based on survival and mortality.

		UGIB (n = 322)
		Survival (n = 232)	Mortality (n = 90)
		n (%)	n (%)	p^a
WBC (/mm^3)	Normal (4000–11,000)	148 (63.8)	39 (43.3)	0.001
	Abnormal (<4000 or >11,000)	84 (36.2)	51 (56.7)
HgB (mg/dL)	Normal (11.3–18.3)	44 (19.0)	18 (20.0)	0.957
	Abnormal (<11.3 or >18.3)	188 (81.0)	72 (80.0)
LDH (IU/L)	Normal (120–240)	44 (19.0)	21 (23.3)	0.471
	Abnormal (<120 or >240)	188 (81.0)	69 (76.7)
Albumin	>median	115 (49.6)	17 (18.9)	<0.001
Median = 3 (g/dL)	≤median	117 (50.4)	73 (81.1)
Blood gas HCO3^−	≤median	121 (52.3)	41 (46.0)	0.419
Medium = 21 (mmol/L)	>median	111 (47.7)	49 (54.0)

Notes: UGIB, upper gastrointestinal bleeding; WBC, white blood cell; LDH, lactate dehydrogenase.

^ap Values were calculated using the chi-square test.

Table 3.  Acid suppressive drugs and ulcerogenic drugs used by patients with uremia in the UGIB group based on survival and mortality.

	UGIB (n = 322)
	Survival (n = 232) n (%)	Mortality (n = 90) n (%)	p^a
Proton-pump inhibitors	163 (70.3)	81 (90.0)	<0.001
H2-receptor antagonists	45 (14.9)	12 (13.3)	0.264
Oral anticoagulant^b	22 (9.5)	9 (10.0)	1.000
Oral antiplatelet^c	36 (15.5)	19 (21.1)	0.302
NSAID^d	54 (23.3)	9 (10.0)	0.011

Notes: UGIB, upper gastrointestinal bleeding; NSAID, nonsteroidal anti-inflammatory drug.

^ap Values were calculated using the chi-square test.

^bWarfarin.

^cAspirin, clopidogrel.

^b,c,dLong-term medication ≥3 months.

Table 4.  Cox proportional hazards model analysis for predicting UGIB outcomes in patients with uremia.

	Crude HR (95% CI)	Adjusted HR (95% CI)
Age	1.02 (1.01–1.04)**	1.02 (1.01–1.04)***
Gender (female/male)	1.25 (0.83–1.90)	1.62 (1.05–2.51)**
Infection during hospitalization	2.81 (1.81–4.35)****	1.85 (1.13–3.03)**
Length of hospital stay – >14 days/ ≤14 days	1.80 (1.14–2.84)**	1.66 (0.97–2.83)
UGIB–single/recurrent episode	2.40 (1.36–4.26)***	2.00 (1.08–3.70)**
HTN	0.55 (0.35–0.85)***	0.69 (0.43–1.09)
Type 2 DM	0.33 (0.13–0.80) **	0.43 (0.17–1.10)
Abnormal WBC count	2.05 (1.35–3.11)****	1.59 (1.03–2.45)**
Albumin – ≤3/> 3 (g/dL)	3.29 (1.94–5.58)****	2.67 (1.51–4.72)****
Proton-pump inhibitors	3.30 (1.66–6.57)****	2.41 (1.16–4.99)**
NSAIDs	0.44 (0.22–0.88)**	0.39 (0.19–0.81)**

Notes: UGIB, upper gastrointestinal bleeding; HR, hazard ratio; CI, confidence interval; HTN, hypertension; DM, diabetes mellitus; WBC, white blood cell; NSAIDs, nonsteroidal anti-inflammatory drugs.

*p < 0.10; **p < 0.05; ***p < 0.01; ****p < 0.001.