NESS - 2010 Annual Meeting Abstracts: Predictors of Death Following Gastroduodenal Artery Embolization for Bleeding Peptic Ulcers

2010 Annual Meeting Abstracts

Predictors of Death Following Gastroduodenal Artery Embolization for Bleeding Peptic Ulcers
*Bernard S Salameh, *Felix Y Lui, *Kevin M Schuster, *W Blake Vanderlan, *Edward A McGillicuddy, *Jeffrey S Pollak, Kimberly A Davis
Yale University School of Medicine, New Haven, CT

Objective: Angiographic embolization of gastroduodenal artery (GDA) hemorrhage is associated with in-hospital re-bleeding in almost 50% of patients. Physiologic parameters were examined as indicators of GDA embolization failure in patients with upper gastro-intestinal (GI) hemorrhage.
Design: Retrospective data collection and analysis.
Setting: Urban, tertiary care center.
Patients: Medical records of all patients that underwent gastroduodenal artery embolization at a tertiary-care, urban hospital from 1/1993-1/2008 were reviewed.
Interventions: Univariate statistical analysis with Fisher’s exact and t-tests; multivariate analysis with logistic regression.
Main Outcome Measures: Mechanical ventilation, transfusion requirements, hemodynamic instability, and death
Results: Out of 375 patients undergoing diagnostic angiography for upper GI hemorrhage, 20 patients underwent therapeutic GDA embolization. Mean patient age was 66 (55% of patients were males) with a mean Acute Physiology and Chronic Health Evaluation (APACHE) score of 19.8 for males and 14.3 for females. 14 patients (70%) were transfused with more than 6 units of packed red blood cells (pRBCs) prior to embolization, and 14 (70%) were anticoagulated at the time of presentation. 16/20 patients (80%) were intubated and 14 patients (70%) required vasopressors prior to embolization. Male gender, mechanical ventilation, transfusion of >6 units of pRBCs, anticoagulation on admission, and hemodynamic instability were associated with death.
Conclusions: Mechanical ventilation, male gender, large transfusion requirement, hemodynamic instability, and pre-intervention anticoagulation may predict poor prognosis following GDA embolization.

Predictors of Death Following GDA Embolization
Predictor Odds Ratio 95% Confidence Interval
Male Gender 0.043 0.234 - 0.785
Mechanical Ventilation 0.018 0.004 - 0.663
>6 Units pRBCs 0.571 0.363 - 0.899
Anticoagulation 0.500 0.296 - 0.844
Hemodynamic Instability 0.571 0.363 - 0.899

Back to Program