The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer

Kim, Bun; Han, Min Seok; Joh, Dong Hoo; Lee, Dong Jun; Shin, Hye Sun; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho

Abstract

BACKGROUND/AIMS
Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients.
METHODS
We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients.
RESULTS
The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (< or =2.5 g/dL) was a risk factor of rebleeding in univariate and multivariate analysis. For patients with chronic liver disease, hypoalbuminemia (< or =2.5 g/dL), renal dysfunction (>2 mg/dL) and thrombocytopenia (<150,000/microL) showed relatively earlier rebleeding than those without (P=0.007, P=0.009, P=0.027 and P=0.043, respectively). The endoscopic hemostasis at the first bleeding event was associated with lower early rebleeding rate (P=0.048). In univariate analysis, chronic liver disease, hypoalbuminemia (< or =2.5 g/dL) and the prolongation of activated partial thromboplastin time (>40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051).
CONCLUSIONS
In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding.