Reductions in 28-Day Mortality Following Hospital Admission for Upper-Gastrointestinal Hemorrhage.
Gastroenterology. 2011 Mar 26;
Authors: Crooks C, Card T, West J
BACKGROUND & AIMS: It is unclear whether mortality from upper gastrointestinal hemorrhage is changing-any differences observed might result from changes in age or co-morbidity of patient populations. We estimated trends in 28-day mortality, in England, following hospital admission for gastrointestinal hemorrhage. METHODS: We used a case-control study design to analyze data from all adults administered to a National Health Service hospital, for upper gastrointestinal hemorrhage, from 1999 to 2007 (n=516,153). Cases were deaths within 28 days of admission (n=74,992) and controls were survivors to 28 days. The 28-day mortality was derived from the linked national death register. A logistic regression model was used to adjust trends in non-variceal and variceal hemorrhage mortality for age, sex, and co-morbidities, and to investigate potential interactions. RESULTS: During the study period, the unadjusted, overall, 28-day mortality following non-variceal hemorrhage was reduced, from 14.7% to 13.1% (unadjusted odds ratio [OR], 0.87; 95% confidence interval [CI], 0.84-0.90). The mortality following variceal hemorrhage was reduced from 24.6% to 20.9% (unadjusted OR, 0.8; 95% CI, 0.69-0.95). Adjustments for age and co-morbidity partly accounted for the observed trends in mortality. Different mortality trends were identified for different age groups following non-variceal hemorrhage. CONCLUSIONS: The 28-day mortality in England following both non-variceal and variceal upper gastrointestinal hemorrhage decreased from 1999 to 2007, and the reduction had been partly obscured by changes in patient age and co-morbidities. Our findings indicate that the overall management of bleeding has improved within the first 4 weeks of admission.
PMID: 21447331 [PubMed - as supplied by publisher]