Rebleeding in peptic ulcer bleeding – a nationwide cohort study of 19,537 patients

Abstract

Background

Rebleeding is a frequent complication of peptic ulcer bleeding (PUB). The associated prognosis remains rather unclear because previous studies generally also included non-ulcer lesions.

Objective

We aimed to identify predictors for rebleeding; clarify the prognostic consequence of rebleeding; and develop a score for predicting rebleeding.

Methods

Nationwide cohort study of consecutive patients presenting to hospital with PUB in Denmark from 2006–2014. Logistic regression analyses were used to identify predictors for rebleeding, evaluate the association between rebleeding and 30-day mortality, and develop a score to predict rebleeding. Patients with persistent bleeding were excluded.

Results

Among 19,258 patients (mean age 74 years, mean ASA-score 2.4), 10.8% rebled, and 10.2% died. Strongest predictors for rebleeding were endoscopic high-risk stigmata of bleeding (Odds Ratio (OR): 2.12 [95% Confidence Interval (CI): 1.91–2.36]), bleeding from duodenal ulcers (OR: 1.87 [95% CI: 1.69–2.08]), and presentation with hemodynamic instability (OR: 1.55 [95% CI: 1.38–1.73]). Among patients with all three factors (7.9% of total), 24% rebled, 50% with rebleeding failed endoscopic therapy, and 23% died. Rebleeding was associated with increased mortality (OR: 2.04 [95% CI: 1.78–2.32]). We were unable to develop an accurate score to predict rebleeding.

Conclusion

Rebleeding occurs in ∼10% of patients with PUB and is overall associated with a two-fold increase in 30-day mortality. Patients with hemodynamic instability, duodenal ulcers, and high-risk endoscopic stigmata are at highest risk of rebleeding. When rebleeding occurs in such patients, consultation with surgery and/or interventional radiology should be obtained prior to repeat endoscopy.

Keywords:

• Peptic ulcer hemorrhage (MeSH term)
• rebleeding
• risk assessment (MeSH term)
• mortality (MeSH term)

Guarantor of the article

SBL is the study guarantor.

Acknowledgment

The authors received no financial support for this study.

Author contributions

The study was designed by SBL and OBSdM. SBL collected data. The statistics were performed by SBL and LL. SBL and AJS wrote the paper with considerable input from LL and OBSdM. All coauthors approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).