Predictors of mortality in patients aged ≥80 years admitted to hospital for upper gastrointestinal hemorrhage

In patients with upper gastrointestinal (UGI) hemorrhage, age ≥ 80 is associated with an increased risk of mortality. The aim of this work was to define the prognostic factors associated with UGI hemorrhage in this age group. Methods: A prospective, longitudinal study of 115 consecutive patients aged 2.80 admitted to hospital during 1988-94. Items of the past medical history, physical status on admission, laboratory and endoscopic data and the hospital course were analyzed by multiple stepwise logistic regression to define the factors independently associated with mortality. Two models were evaluated: The first based on the data at presentation (history, physical status, initial laboratory workup) and the second based on the first, plus the endoscopic and follow up data. Age was incorporated into these models as a potential confounder. Results: The mean age was 84±0.4 years (SEM). The main causes of bleeding were duodenal ulcer (30%); esophagitis (21%); gastric ulcer (20%) and gastritis (6%). The overall mortality was 13%. A multivariate analysis indicated two independent predictors of mortality: At. presentation- a systolic blood pressure ≤ 90 mm Hg (adjusted odds ratio 4.6; 95% CI 1.1-18.2; p= 0.03). The overall predictor of mort ality was a persistent or recurrent bleeding (adjusted odds ratio 35.9; 95% CI 7-193; p<0.0001). Conclusions: In patients aged ≥80 admitted to hospital for acute UGI bleeding: 1 : Continuous bleeding was the most important prognostic factor. 2: Increasing age and the causes of bleeding were of no prognostic significance.