Age as a key predictor of 6-week mortality in cirrhotic patients with acute gastrointestinal bleeding: a retrospective cohort study.

BACKGROUND

Acute gastrointestinal bleeding (AGIB) in patients with liver cirrhosis is a frequent and often fatal event. This study aimed to thoroughly characterize the relationship between patients' age and 6-week mortality. We sought to identify specific risk thresholds and key modifying factors to refine clinical risk stratification.

METHODS

We conducted a retrospective analysis of 878 patients with liver cirrhosis and AGIB admitted to the Emergency Room at Beijing You'an Hospital. Patients were stratified into age-based tertiles for descriptive analysis. To assess the association between age and 6-week mortality, we built three sequential logistic regression models adjusting for key clinical confounders including the Glasgow-Blatchford Score (GBS), using restricted cubic splines (RCS) to capture non-linear effects and identify risk thresholds. Subgroup analyses and formal tests for interaction were performed to evaluate the consistency of the age-related risk across different clinical scenarios.

RESULTS

The 6-week mortality rate was highest in the oldest age tertile (18.21%). Age emerged as a significant and independent predictor of mortality in all models. The fully adjusted RCS model identified a critical age threshold of approximately 58 years, above which mortality risk increased sharply. The prognostic impact of age was particularly pronounced in male patients and those not receiving endoscopic therapy. Notably, a significant interaction was detected between age and intensive care unit (ICU) admission status (P for interaction < 0.05). The strong association between increasing age and higher mortality observed in non-ICU patients was attenuated and no longer significant in those admitted to the ICU. A significant association between increasing age and 6-week mortality was identified in patients with Child-Pugh grade C (p < 0.001), and in medium-risk and high-risk groups (both p = 0.011) when patients were stratified based on GBS. Additionally, in the etiological subgroups, age was a significant predictor of 6-week mortality only in patients with viral cirrhosis (p = 0.002) and viral/alcoholic cirrhosis (p = 0.01), but not in patients with other etiologies.

CONCLUSION

Age is a critical independent predictor of 6-week mortality in cirrhotic patients with AGIB, but its prognostic effect varies with the level of care. Specifically, It strongly predicts mortality in non-ICU settings, but not in the ICU. This challenges the uniform view of age as a risk factor and suggests that early transfer to higher-level care such as ICU admission may reduce age-related risk in this vulnerable population.