Emergency Department Predictors of Mortality and Adverse Outcomes in Upper Gastrointestinal Bleeding: A 5-Year Retrospective Cohort Study.

BACKGROUND

Upper gastrointestinal bleeding (UGIB) frequently presents to the emergency department (ED). Existing scores (Glasgow-Blatchford, etc.) may not capture early ED predictors of adverse outcomes.

OBJECTIVES

To identify independent ED predictors of in-hospital mortality and adverse outcomes in endoscopically confirmed UGIB.

METHODS

We conducted a 5-year retrospective cohort at a tertiary ED. Adults (≥18 years) with hematemesis, melena, or hematochezia and endoscopic confirmation were included. We extracted demographics, comorbidities, vital signs, laboratory values (including admission lactate), ED resuscitation, and endoscopic findings. Outcomes were in-hospital mortality and a composite of adverse outcome (intensive care unit admission, transfusion, or rebleeding). Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

RESULTS

Of 2527 screened, 476 met criteria (median age 66 years; 69.5% male). Adverse outcomes occurred in 208 patients (43.7%), and in-hospital mortality was 5.7%. Independent predictors were hemodynamic instability (aOR 3.24, 95% CI 1.89-5.61), chronic liver disease (2.87, 1.49-5.52), lower hemoglobin (1.42, 1.12-1.80), need for intravenous fluids (2.98, 1.76-5.04), active endoscopic bleeding (5.12, 2.23-11.76), and higher lactate (1.36, 1.14-1.63). In adjusted analyses, in-hospital mortality was independently associated with active endoscopic bleeding, history of malignancy, and higher admission lactate. In receiver operating characteristic (ROC) analyses, adding lactate improved discrimination for in-hospital mortality (area under the ROC curve [AUC] 0.73 vs. 0.61; ΔAUC 0.119, 95% CI 0.065-0.173; p < 0.001).

CONCLUSION

Admission lactate, hemodynamic instability, and active endoscopic bleeding are robust early predictors of mortality and adverse outcomes in UGIB. Integrating these markers with existing scores may refine ED risk stratification and guide timely interventions.