Prognostic indices of upper gastrointestinal bleeding in patients in the Emergency Department


  • Thongsujaritkul C Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
  • Sutham K Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
  • Wittayachamnankul B Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
  • Chenthanakij B Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
  • Tangsuwanaruk T Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai


esophagogastroduodenoscopy, gastrointestinal hemorrhage, emergency department length of stay, mortality


Objectives  Upper gastrointestinal bleeding (UGIB) is a common but potentially fatal condition often seen in the emergency department (ED). This study aimed to investigate prognostic factors, including the emergency department length of stay (ED LOS), office hours vs. non-office hours visits, performance of an esophagogastroduodenoscopy (EGD) including time from admission to performance of the EGD which could potentially affect in-hospital all-cause mortality.

Methods A retrospective study was conducted of patients with UGIB in the ED of Maharaj Nakorn Chiang Mai Hospital during 2017. Univariable and multivariable logistic regression were used.

Results  A total of 132 patients were included with a total of 19 deaths (14.4%). Logistic regression showed the presence of any liver disease, systolic blood pressure < 90 mmHg, hemoglobin 7 g/dL, platelet count 100,000 per mm3, International Normalized Ratio (INR) 1.2, a high Glasgow-Blatchford bleeding score, intravenous fluid 1,000 mL, administration of blood components, use of octreotide and/or tranexamic acid were found to be associated with increased mortality (p < 0.05). There was no evidence that either ED LOS ≥ 180 minutes after admission or a non-office hours visit were associated with mortality (p > 0.05) although EGD following admission was associated with decreased mortality (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.07 to 0.52, p = 0.001). In multivariable analysis, only EGD following admission (OR 0.01, 95% CI 0.01 to 0.1, p = 0.001) was associated with decreased mortality.  In multivariable subgroup analysis, no evidence was found that EGD within the first 24 hours after admission (early EGD) was related to decreased mortality compared with EGD after the first 24 hours (late EGD).

Conclusions EGD following hospital admission can decrease mortality. However, there was no evidence that a longer ED LOS, whether admission occurred during office hours or outside of office hours or early vs. late EGD were associated with in-hospital all-causes mortality.


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1. Loperfido S, Baldo V, Piovesana E, Bellina L, Rossi K, Groppo M, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70:212–24.
2. Kaya E, Karaca MA, Aldemir D, Ozmen MM. Predictors of poor outcome in gastrointestinal bleeding in emergency department. World J Gastroenterol. 2016; 22:4219–25.
3. Oakland K. Changing epidemiology and etiology of upper and lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2019;42–43:101610.
4. Hearnshaw SA, Logan RFA, Lowe D, Travis SPL, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60:1327–35.
5. Imperiale TF, Dominitz JA, Provenzale DT, Boes LP, Rose CM, Bowers JC, et al. Predicting poor outcome from acute upper gastrointestinal hemorrhage. Arch Intern Med. 2007;167:1291–6.
6. Groot NL de, Bosman JH, Siersema PD, Oijen MGH van. Prediction scores in gastrointestinal bleeding: a systematic review and quantitative appraisal. Endoscopy. 2012;44:731–9.
7. Chiu PWY, Ng EKW, Cheung FKY, Chan FKL, Leung WK, Wu JCY, et al. Predicting mortality in patients with bleeding peptic ulcers after therapeutic endoscopy. Clin Gastroenterol Hepatol. 2009;7:311–6.
8. Olmo JA del, Peña A, Serra MA, Wassel AH, Benages A, Rodrigo JM. Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol. 2000;32:19–24.
9. Jairath V, Kahan BC, Stanworth SJ, Logan RFA, Hearnshaw SA, Travis SPL, et al. Prevalence, management, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom. Transfusion. 2013;53:1069–76.
10. Zhou YJ, Zheng JN, Zhou YF, Han YJ, Zou TT, Liu WY, et al. Development of a prognostic nomogram for cirrhotic patients with upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2017;29:1166–73.
11. Shingina A, Barkun AN, Razzaghi A, Martel M, Bardou M, Gralnek I. Systematic review: the presenting international normalised ratio (INR) as a predictor of outcome in patients with upper nonvariceal gastrointestinal bleeding. Aliment Pharmacol Ther. 2011;33:1010–8.
12. Singer AJ, Jr HCT, Viccellio P, Pines JM. The association between length of Emergency Department boarding and mortality. Acad Emerg Med. 2011;18:1324–9.
13. Boudi Z, Lauque D, Alsabri M, Östlundh L, Oneyji C, Khalemsky A, et al. Association between boarding in the Emergency department and in-hospital mortality: A systematic review. PLoS One. 2020;15:e0231253.
14. Shaheen AAM, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7:303–10.
15. Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenterol Hepatol. 2009;7:296-302.e1.
16. Tufegdzic M, Panic N, Boccia S, Malerba S, Bulajic M, La Vecchia C, et al. The weekend effect in patients hospitalized for upper gastrointestinal bleeding: a single-center 10-year experience. Eur J Gastroenterol Hepatol. 2014;26:715–20.
17. Groot NL de, Bosman JH, Siersema PD, Oijen MGH van, Bredenoord AJ. Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study. Aliment Pharmacol Ther. 2012;36:477–84.
18. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–13.
19. Schacher GM, Lesbros-Pantoflickova D, Ortner MA, Wasserfallen JB, Blum AL, Dorta G. Is early endoscopy in the Emergency Room beneficial in patients with bleeding peptic ulcer? A fortuitously controlled study. Endoscopy. 2005;37:324–8.
20. Laursen SB, Leontiadis GI, Stanley AJ, Møller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc. 2017;85:936-44.e3
21. Yoo J-J, Chang Y, Cho EJ, Moon JE, Kim SG, Kim YS, et al. Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding. World J Gastroenterol. 2018;24:5025–33.
22. Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi–detector row helical CT. Radiology. 2006;239:160–7.
23. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003; 139:843–57.
24. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997;315:510–4.
25. Sangchan A, Sawadpanitch K, Mairiang P, Chunlertrith K, Sukeepaisarnjaroen W, Sutra S, et al. Hospitalized incidence and outcomes of upper gastrointestinal bleeding in Thailand. J Med Assoc Thai. 2012;95:S190–5.
26. Peng Y, Qi X, Dai J, Li H, Guo X. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis. Int J Clin Exp Med. 2015;8:751–7.
27. Kuo MT, Yang SC, Lu LS, Hsu CN, Kuo YH, Kuo CH, et al. Predicting risk factors for rebleeding, infections, mortality following peptic ulcer bleeding in patients with cirrhosis and the impact of antibiotics prophylaxis at different clinical stages of the disease. BMC Gastroenterol. 2015;15:61.
28. Quan S, Frolkis A, Milne K, Molodecky N, Yang H, Dixon E, et al. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World J Gastroenterol. 2014;20:17568–77.
29. Zhang Z, Bokhari F, Guo Y, Goyal H. Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission. Emerg Med J. 2019;36:82–7.
30. Liu L, Hao D, Liu W, Wang L, Wang X. Does weekend hospital admission affect upper gastrointestinal hemorrhage outcomes?: A systematic review and network meta-analysis. J Clin Gastroenterol. 2020;54:55–62.
31. Jairath V, Kahan BC, Logan RFA, Hearnshaw SA, Travis SPL, Murphy MF, et al. Mortality from acute upper gastrointestinal bleeding in the United kingdom: does it display a “weekend effect”? Am J Gastroenterol. 2011;106:1621–8.
32. Spiegel BM, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med. 2001;161:1393–404.
33. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019;171:805–22.
34. Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip H-C, Chan SM, et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020;382:1299–308.




How to Cite

C T, K S, B W, B C, T T. Prognostic indices of upper gastrointestinal bleeding in patients in the Emergency Department. Chiang Mai Med J. [Internet]. 2021 Jul. 1 [cited 2023 Mar. 29];60(3):291-302. Available from:



Original Article