• Eduardo Redondo-Cerezo, Cristina Tendero-Peinado, Jose María López-Tobaruela, Raúl Fernandez-García, Ana Lancho, Eva Julissa Ortega-Suazo, Manuel López-Vico, Juan Gabriel Martínez-Cara, and Rita Jiménez-Rosales.
• Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain; Department of Medicine The University of Granada School of Medicine Granada Spain; Instituto de Investigación Biosanitaria de Granada (ibs.Granada) Granada Spain. Electronic address: eredondoc@ugr.es.
• Am. J. Med. Sci. 2024 Apr 1; 367 (4): 259267259-267.

BackgroundMassive gastrointestinal bleeding is a life-threatening condition without a well-established definition. We aimed to analyze the characteristics, risk factors, and outcomes of patients with massive upper gastrointestinal bleeding.MethodsOur study analyzed a prospective registry of patients admitted between 2013 and 2020 with variceal and non-variceal causes. Severe bleeding was defined as ongoing bleeding requiring transfusion of more than 2 units of packed red blood cells within 24 hours, accompanied by signs of shock. The main outcomes were 30-day and 6-month mortality, rebleeding within 7 days, persistent bleeding, and severe complications during admission.ResultsOut of 1213 patients, 171 had massive gastrointestinal bleeding, with a predominance of males. The massive bleeding group had higher rates of chronic kidney disease, cirrhosis, in-patient status, disseminated malignancy, alcoholism, and ASA score ≥3. All major outcomes, including 30-day mortality, 6-month mortality, rebleeding, persistent bleeding, and severe complications, were more common in the massive bleeding group. Multivariate logistic regression identified inpatient status, systemic diseases, malignancy, active bleeding in endoscopy, and severe complications as risk factors for massive bleeding and mortality.ConclusionsInpatient status and comorbidities, especially systemic diseases, and malignancies, were associated with a higher risk of massive bleeding. Mortality was linked to chronic kidney disease, cirrhosis, severe comorbidities, and alcohol consumption. We observed increased 6-months mortality, probably related to a health status in which gastrointestinal bleeding heralded poor outcomes, some of them potentially preventable. Innovative healthcare interventions, such as Emergency Department-based intermediate care areas or Intensive Care Units, and multidisciplinary follow-up, could potentially improve survival.Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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