Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly

Table 1 Characteristics of patients for the entire group and for each cohort

	Total	Patients aged≥65 yr	Patients aged < 65 yr	P value
	(n = 526)	(n = 235)	(n = 291)
Age (yr)	60 ± 15.9	74.2 ± 6.7	48.4 ± 11.1	< 0.001
Male: n (%)	370 (70)	148 (63)	222 (76)	< 0.001
Presenting symptoms: 1n (%)
Hematemesis	207 (39)	65 (28)	142 (49)	< 0.001
Melena	214 (41)	126 (53)	88 (30)	< 0.001
“Coffee ground” vomiting	86 (16)	36 (15)	50 (17)	0.57
Hematochezia	19 (4)	8 (4)	11 (4)	0.82
Clinical findings: n (%)
Red blood on nasogastric lavage	97 (18)	41 (17)	56 (19)	0.60
Systolic blood pressure < 100 mmHg	163 (31)	62 (26)	101 (35)	0.04
Heart rate > 100 beats/min	192 (37)	63 (27)	129 (44)	< 0.001
Presence of hemodynamic instability	313 (60)	114 (49)	199 (68)	< 0.001
Comorbid illness: 1n (%)
Cardiovascular disease	109 (21)	81 (34)	28 (10)	< 0.001
Cerebrovascular disease	49 (9)	34 (14)	15 (5)	< 0.001
Chronic renal failure	37 (7)	17 (7)	20 (7)	0.87
Liver cirrhosis	140 (27)	45 (19)	95 (33)	< 0.001
Cancer	64 (12)	33 (14)	31 (11)	0.24
Diabetes mellitus	126 (24)	87 (37)	39 (1)	< 0.001
Hypertension	186 (35)	125 (53)	61 (21)	< 0.001
Alcohol drinking: n (%)	246 (47)	66 (28)	180 (62)	< 0.001
Previous use of medications: 1n (%)
Low-dose aspirin	111 (21)	82 (35)	29 (10)	< 0.001
Clopidogrel	33 (6)	30 (13)	3 (1)	< 0.001
Warfarin	38 (7)	22 (9)	16 (6)	0.09
NSAID other than aspirin	123 (23)	57 (24)	66 (23)	0.67
Laboratory features at presentation:
Hemoglobin (g/dL)	8.7 ± 4.7	8.4 ± 2.3	9.0 ± 6.0	0.19
White blood count (103/μL)	11.8 ± 8.1	11.2 ± 5.3	12.3 ± 9.7	0.15
Platelets (103/μL)	232 ± 125	242 ± 116	223 ± 131	0.09
Prothrombin time (s)	13.4 (11.4-248)	13.2 (11.4-160)	13.9 (11.4-248)	0.84
Creatinine (mg/dL)	1.1 (0.2-11.8)	1.3 (0.4-10.8)	0.9 (0.2-11.8)	0.44

Categorical variables are presented as number and percentage, and continuous variables are presented as the mean ± SD or median and range when appropriate.

¹Some patients presented with more than 1 symptom or comorbid illness and used more than 1 drug. NSAID: Non-steroidal anti-inflammatory drug.

Table 2 Endoscopic findings for the entire group and for each cohort

	Total	Patients aged≥65 yr	Patients aged < 65 yr	P value
	(n = 526)	(n = 235)	(n = 291)
Peptic ulcer as source of bleeding: 1n (%)
Active bleeding	19 (4)	11 (5)	8 (3)	0.20
Non-bleeding visible vessel	59 (11)	25 (11)	34 (12)	0.71
Clot with underlying vessel	16 (3)	8 (3)	8 (3)	0.66
Flat, pigmented spot	41 (8)	23 (10)	18 (6)	0.13
Clean base	224 (46)	112 (48)	112 (38)	0.03
Portal hypertensive related-lesions as source of bleeding: 1n (%)
Esophageal varices	137 (26)	41 (17)	96 (33)	< 0.001
Gastric and duodenal varices	17 (3)	4 (2)	14 (5)	0.051
Portal hypertensive gastropathy	58 (11)	17 (7)	41 (14)	0.01
Other endoscopic findings: 1n (%)
Esophageal ulcer	19 (4)	9 (4)	10 (3)	0.81
Esophagitis	36 (7)	17 (7)	19 (7)	0.75
Gastropathy, duodenitis, or erosions	129 (25)	61 (26)	68 (23)	0.49
Mallory-Weiss tear	26 (5)	5 (2)	21 (7)	0.007
Gastric cancer	15 (3)	6 (3)	9 (3)	0.71
Dieulafoy’s lesion	11 (2)	6 (3)	5 (2)	0.51
Angiodysplasia	2 (0.004)	1 (0.4)	1 (0.3)	0.88
No clinically significant finding	11 (2)	3 (1)	8 (3)	0.24

¹Some patients presented with more than 1 endoscopic finding.

Table 3 Clinical outcomes after pharmacologic and endoscopic therapy

	Patients aged≥65 yr	Patients aged < 65 yr	P value	Relative risk
	(n = 235)	(n = 291)		(95% CI)
Urgent Endoscopy: n (%)	47 (20)	64 (22)	0.58	0.91 (0.65-1.27)
For peptic ulcers bleeding	22 (14)	29 (18)	0.33	0.78 (0.47-1.29)
For variceal bleeding	16 (46)	30 (37)	0.36	1.25 (0.79-1.98)
Endoscopic therapy for bleeding peptic ulcers: 1n (%)	45 (28)	55 (34)	0.29	0.84 (0.60-1.16)
Epinephrine injection	36 (80)	50 (91)	0.12
Coaptive thermocoagulation	28 (62)	39 (71)	0.36
Hemostatic clip	11 (24)	14 (25)	0.91
Combined therapy	29 (64)	42 (76)	0.19
Endoscopic therapy for variceal bleeding: 1n (%)	27 (66)	72 (75)	0.34	0.89 (0.69-1.14)
Esophageal band ligation	25 (93)	64 (89)	0.59
Cyanoacrylate injection	3 (11)	10 (14)	0.72
The 72-h infusion of PPI after endoscopic therapy for bleeding peptic ulcers: n (%)	47 (29)	49 (30)	0.84	0.97 (0.69-1.35)
The 3-5 d infusion of vasoactive agent after endoscopic therapy for variceal bleeding: n (%)	27 (66)	73 (76)	0.22	0.87 (0.68-1.11)
Units of blood transfused:
Before endoscopy	1.8 ± 1.4	1.8 ± 1.6	0.88
During hospitalization	2.7 ± 0.2	2.9 ± 0.2	0.33
Hospital stay (d)	5 (1-14)	4 (1-13)	0.84
Hospital stay < 3 d: n (%)	85 (36)	106 (36)	0.95	0.99 (0.79-1.25)
Recurrent bleeding: n (%)
Within 3 d	11 (5)	11 (4)	0.61	1.24 (0.55-2.81)
Within 7 d	22 (9)	17 (6)	0.13	1.60 (0.87-2.95)
Within 30 d	36 (15)	31 (11)	0.11	1.44 (0.92-2.25)
Emergency surgery: n (%)	1 (0.4)	4 (1.4)	0.26	0.31 (0.03-2.75)
Death within 30 d: n (%)	16 (7)	18 (6)	0.77	1.10 (0.57-2.11)

Categorical variables are presented as number and percentage, and continuous variables are presented as the mean ± SD or median and range when appropriate. CI: Confidence interval.

¹Some patients were treated with more than 1 endoscopic modality.

Table 4 Prognostic factors for rebleeding and mortality in acute upper gastrointestinal bleeding

Variable	Parameter estimate	Standard error	Hazard ratio	P value
			(95% CI)
Prediction for Recurrent bleeding
Number of blood transfusions
before endoscopy	0.22	0.07	1.25 (1.08-1.42)	0.003
Stigmata of recent bleeding	0.99	0.26	2.68 (1.58-4.41)	< 0.001
Prediction for Mortality
Hemodynamic instability	0.95	0.50	2.57 (1.05-7.76)	0.04
Liver cirrhosis	1.33	0.62	3.77 (1.10-12.2)	0.03
Disseminated malignancy	1.8	0.65	6.06 (1.37-18.8)	0.02
Number of blood transfusions	0.11	0.03	1.12 (1.03-1.19)	0.004
Recurrent bleeding	1.62	0.39	5.07 (2.30-10.9)	< 0.001
Variceal bleeding	0.51	0.61	1.66 (0.55-5.79)	0.39

CI: Confidence interval.