Prognostic Factors of Mortality in Seriously-Ill Patients with High Nonvariceal Gastrointestinal Bleeding

Abstract

Introduction: The prognosis of dying from digestive bleeding allows individualizing treatment and reducing mortality.

Objectives: To identify the prognostic factors of mortality due to nonvariceal gastrointestinal bleeding in seriously-ill patients.

Methods: Cases and controls were studied in patients admitted to the intensive care unit of Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital, between January 1, 2018 and December 31, 2019. The universe consisted of 1060 patients, 154 of which were selected to make up the sample (137 controls and 17 cases). Chi-square and odds ratio (CI: 95%) were applied.

Results: Of the total of patients studied, 11.3% died, the average age was 69±11.58 (control group) and 75±11.42 (case group). Alterations in acid-base balance accounted for 7.4 as risk of dying (CI: 95%; 2.5-21.9), hypoxia accounted for 1.1 (CI: 95%; 0.41-3.2), variations in potassium accounted for 4.9 (CI: 95%; 1.54-16.1), hyperlacthemia accounted for 16.9 (CI: 95%; 5.3-52.0), and sodium deviations accounted for 6.5 (CI: 95%; 0.8-51, 4), mechanical ventilation accounted for 2.17 (CI: 95%; 0.6-7.0), vasoactive amines support accounted for 16.9 (CI: 95%; 5.30-52.0), red blood cell transfusion accounted for 11.7 (CI: 95%; 3.1-4.3), dialysis treatment accounted for 47.5 (CI: 95%; 8.6-258.0), and complications accounted for 3.4 (CI: 95%; 1.15-10.4). Endoscopic treatment was 93.5% in the control group and 41.3% in the case group, with odds ratio at 0.04 (CI: 95%; 0.01-0.15).

Conclusions: The prognostic factors identified were alterations in pH, sodium, potassium, elevated lactate, mechanical ventilation, transfusions of more than 250 mL of red blood cells, vasoactive amine support, dialysis treatment, and complications related to bleeding. Endoscopic treatment was a protective factor.