Marmo et al identified factors predictive of mortality associated with nonvariceal upper gastrointestinal hemorrhage. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in Italy.


Patient selection: nonvariceal upper gastrointestinal hemorrhage (peptic ulcer, Mallory-Weiss tear, tumor, esophagitis, Dieulafoy lesion, etc)


Outcome: 30 day mortality


Risk factors for mortality form logistic regression analysis:

(1) renal failure, cirrhosis, advanced neoplasia, or other severe comorbid condition

(2) advanced age (over 80 years of age)

(3) worsening health status (ASA Class 3 or 4)

(4) severe anemia (hemoglobin < 7 g/dL)


Additional risk factors:

(1) failure to use a proton pump inhibitor (use of a PPI protective)

(2) failed intention to endoscopic treatment (inability to control the source of bleeding during endoscopy, page 1650)

(3) delayed presentation of the patient


In the absence of risk factors the mortality is low.


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