Predictors and Outcomes of Massive Bleeding in Acute Upper Gastrointestinal Bleeding: Insights from a multicentre prospective UK cohort study

Aims Massive bleeding in acute upper gastrointestinal bleeding (AUGIB) is linked to significant morbidity and mortality. This study characterised patients with massive bleeding, identified predictors, and evaluated outcomes, including mortality and rebleeding.

Methods Data from the 2022 UK AUGIB audit [1], including 4,339 patients undergoing endoscopy, were analysed. Massive bleeding was defined as haemodynamic instability and transfusion of>2 packed red cells within 24 hours of presentation. Patient characteristics, management, and outcomes were compared using univariate analysis. Multivariate logistic regression identified predictors of massive bleeding, mortality, and rebleeding.

Results Among 4,339 patients, 598 (14%) had massive bleeding. These patients were younger (median 68 vs. 69 years, p=0.03), predominantly male (65% vs. 59%, p=0.01), and had worse haemodynamic and laboratory parameters, including lower systolic blood pressure (SBP) (99 vs. 124 mmHg, p<0.001), higher heart rate (105 vs. 89 bpm, p<0.001), lower haemoglobin (69 vs. 98 g/L, p<0.001), and higher lactate (2.80 vs. 1.80 mmol/L, p<0.001). Hepatic disease (29% vs. 18%, p<0.001), varices (25% vs. 13%, p<0.001), and higher Glasgow-Blatchford Scores (13 vs. 8, p<0.001) were more common. Massive bleeding patients had more endoscopic stigmata of bleeding (48% vs. 28%, p<0.001) and required more interventions, including therapeutic endoscopy (43% vs. 25%, p<0.001), interventional radiology (5.0% vs. 2.4%, p<0.001), and surgery (2.4% vs. 0.5%, p<0.001). Massive bleeding was associated with higher mortality (12% vs. 6.8%, p<0.001), rebleeding (18% vs. 9.8%, p<0.001), and longer hospital stays (7 vs. 5 days, p<0.001). Predictors of mortality included inpatient status (OR 3.25, 95% CI 1.91–5.49), hepatic disease (OR 2.19, 95% CI 1.10–4.30), renal disease (OR 2.23, 95% CI 1.24–3.94), and the need for IR (OR 4.52, 95% CI 2.05–9.53). Higher SBP at presentation (OR 0.98, 95% CI 0.97–0.99) and presentation with melaena (OR 0.61, 95% CI 0.38–0.98) were associated with lower mortality. Predictors of rebleeding included inpatient status (OR 2.17, 95% CI 1.25–3.73), pre-endoscopy vasopressor use (OR 2.68, 95% CI 1.33–5.48), and endoscopic stigmata of bleeding (OR 2.22, 95% CI 1.28–3.89). Higher haemoglobin (OR 0.98, 95% CI 0.98–0.99) and melaena (OR 0.64, 95% CI 0.41–0.99) were associated with reduced rebleeding

Conclusions Massive bleeding patients experience worse outcomes, including higher mortality, rebleeding, and longer hospitalisation. Predictors such as low SBP, high heart rate, low haemoglobin, and endoscopic stigmata of bleeding can guide early identification of high-risk patients. Addressing comorbidities and prompt resuscitation are key to improving outcomes.

Publication History

Article published online:
27 March 2025

• References

• 1 Nigam G, Davies P, Dhiman P. et al P31 Trends in acute upper GI bleeding: insights from 2022 UK audit with 5000 patients. Gut 2024; 73: A67-A68