Bleeding peptic ulcer in Hong Kong: Stratification of risk factors

In order to validate previously derived sets of risk factors, 1441 patients with acute non-variceal gastro-intestinal bleeding from peptic ulcer disease who had been admitted to our hospital from June 1985 to January 1994 were studied. Of these patients, 1035 (72%) had at least one risk factor, 98 had rebleeding and 43 died. Common risk factors for rebleeding and mortality were an age of over 60 years and a total transfusion requirement of greater than five units of blood. Risk factors for rebleeding also included an admission haemoglobin of 10 g/dl or less, endoscopic stigmata of recent haemorrhage and shock, whereas risk factors for mortality were concomitant medical illness, an ulcer larger than 1 cm and rebleeding. The risk of rebleeding increased progressively with an increasing number of risk factors: 1.5%, 4.9%, 18.6%, 21.4% and 60% in patients with one to five risk factors, respectively. Similarly, the corresponding risk of mortality was 1.3%, 1.8%, 10.1%, 23.1% and 50%, respectively. These findings regarding rebleeding and mortality were statistically significant. Patients with two or more risk factors merit aggressive management with consideration of early therapeutic endoscopy.