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Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis
Author(s) -
Zhan Xian Bao,
Guo Xiao Rong,
Yang Jing,
Li Jie,
Li Zhao Shen
Publication year - 2015
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12206
Subject(s) - medicine , acute pancreatitis , upper gastrointestinal bleeding , apache ii , gastroenterology , pancreatitis , univariate analysis , risk factor , creatinine , surgery , multivariate analysis , intensive care unit , endoscopy
Objective To investigate the prevalence and risk factors of upper gastrointestinal bleeding ( UGIB ) in patients with severe acute pancreatitis ( SAP ). Methods Altogether 101 patients were admitted to the Department of Gastroenterology, Changhai Hospital, Second Medical Military Hospital from J uly 2006 to J une 2010 due to SAP. Their prevalence and risk factors of UGIB were retrospectively analyzed. Results In total, 18 (17.8%) patients developed UGIB and 13 received endoscopic examination, which yielded six cases of acute gastric mucosal lesions ( AGML ), five of peptic ulcers (PU) and two of pancreatic necrotic tissue invading the duodenal bulb and presenting as multilesion, honeycomb‐like ulcer. The mortality rate of UGIB patients was much higher than that of non‐ UGIB patients (44.4% vs 10.8%, P = 0.0021). Univariate analysis revealed that the risk factors for UGIB included the Acute Physiology and Chronic Health Evaluation II ( APACHE II ) score, computed tomography severity index (CTSI), Ranson score, arterial blood pH and PaO 2 , serum blood urea nitrogen and creatinine concentrations, platelet count, shock, sepsis and organ failure, mechanical ventilation, heparinized continuous renal replacement therapy and total parenteral nutrition. Multivariate logistic regression revealed that APACHE II score and CTSI were significant risk factors while PaO 2 was the protective factor for UGIB in SAP. Conclusions UGIB is a common complication with poor prognosis due mainly to PU and AGML . Patients having SAP with high APACHE II scores and CTSI or low PaO 2 should be considered to be at high risk for UGIB .