Abstract:
Background: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially
fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of
management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in
these patients.
Methods: This was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults
admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings
were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and
cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate
analysis, respectively.
Results: A total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the
study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause
of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer
disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with
high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum
total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported
in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%)
Conclusions: Oesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper
gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates
were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent
predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more
aggressive management.
