急性非静脉曲张性上消化道出血患者院内死亡因素分析

Analysis of the Factors Affecting the In-Hospital Mortality of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding

目的研究急性非静脉曲张性上消化道出血(ANVUGIB)患者院内死亡的影响因素。方法选取2016年1月至2017年11月武汉大学人民医院收治的588例ANVUGIB患者为研究对象,根据院内死亡与否分为生存组(554例)和死亡组(34例),分析两组性别、年龄、合并症、出血史、抗凝药物使用史、入院时人血清白蛋白(Alb)、血红蛋白(Hb)及治疗方法方面的差异及ANVUGIB患者院内死亡的影响因素。结果 ANVUGIB院内病死率为5.78%(34/588),女性,年龄偏低,内镜治疗的患者院内病死率较低,生存组较死亡组入院时Alb和Hb较高,而两组合并症、出血史及抗凝药物使用史比较差异无统计学意义(P>0.05);受试者工作特征曲线下面积(AUC)为0.731,Alb的最佳截断值为34.9 g/L;多因素Logistic回归分析结果显示,出血史(OR=0.323,95%CI 0.108~0.968,P=0.044),治疗方法 (OR=0.280,95%CI 0.096~0.820,P=0.020)是患者院内死亡的不利因素,性别(OR=4.746,95%CI 1.066~21.128,P=0.041)、Alb≤34.9 g/L(OR=4.237,95%CI 1.524~11.785,P=0.006)及合并症(OR=2.316,95%CI 1.069~5.017,P=0.033)是院内死亡的影响因素。结论性别、出血史、合并症、治疗方法及Alb≤34.9 g/L是ANVUGIB患者院内死亡的影响因素,Alb≤34.9 g/L对ANVUGIB患者院内死亡风险有一定的预测作用。

Objective To study the factors affecting the in-hospital mortality of patients with acute nonvariceal upper gastrointestinal bleeding（ ANVUGIB）. Methods The patients with ANVUGIB admitted to Renmin Hospital of Wuhan University from Jan. 2016 to Nov. 2017. A total of 584 patients were divided into two groups,a survival group（ 554 patients） and a death group（ 34 patients）. The differences in gender,age,complications,history of bleeding,anticoagulants,admassion albumin（ Alb） level,admassion heruoglobin（ Hb） level and treatment methods between the two groups were compared,and the risk factors for ANVUGIB patients in-hospital mortality were analyzed. Results The risk of ANVUGIB in-hospital mortality was 5. 78%（ 34/588）,the results showed that the survival group had higher level in Alb and Hb;femal,younger or under endoscopic therapy patients had significantly lower in-hospital mortality rate; and there were no significant differences in complications,history of bleeding and anticoagulants. Area under the receiver operating characteric curve = 0. 731,P〈0. 001,the best cutoff value of Alb was 34. 9 g/L; multiariable Logistic regression analysis showed that the history of bleeding（ OR = 0. 323,95% CI 0. 108-0. 968,P = 0. 044）,treatment methods（ OR = 0. 280,95% CI 0. 096-0. 820,P = 0. 02） were negative factors for in-hospital mortalityl; gender（ OR = 4. 746,95% CI 1. 066-21. 138,P =0. 041）,complications（ OR = 2. 316,95% CI 1. 069-5. 017,P = 0. 033） and Alb≤34. 9 g/L（ OR = 4. 237,95% CI 1. 524-11. 785,P = 0. 006） were positive factors for in-hospital mortality. Conclusion Gender,history of bleeding,complications,Alb≤34. 9 g/L and the treatment method are factors affecting the NVUGIB in-hospital mortality; and the level of the admission Alb≤34. 9 g/L could predict the risk of NVUGIB in-hospital mortality to a certain degree.