Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses, and outcomes in the 2022 prospective audit of 5000 patients
Bibliographic record
Abstract
<strong>Aims:</strong> With the evolving landscape of acute upper GI bleeding (AUGIB) management, a comprehensive understanding of changing clinical outcomes becomes imperative. This report presents findings from the 2022 UK-wide multi-centre AUGIB audit, drawing comparisons to the previous 2007 study. <br> <strong>Methods:</strong> A prospective multi-centre audit, conducted between May 3 and July 2, 2022, included adults (≥16 years) presenting with AUGIB in UK hospitals. <br> <strong>Results:</strong> Data on 5101 patients (median age 69yr) from 152 participating hospitals are reported. New admissions with AUGIB (n=3905) were younger than inpatients developing AUGIB (median age 67.5 vs 74 yrs, respectively) with fewer comorbidities (63% vs 80%, respectively). At presentation, 17% (877/5101) had chronic liver disease (CLD), 30% (n=1528) a history of regular alcohol use, 7% (n=371) were taking non-steroidal anti-inflammatory drugs and 46%(n=2339) antiplatelets and/or anticoagulants (18% direct oral anticoagulants, 10% heparin and 3% warfarin). 83%(n=4228) patients had an inpatient endoscopy; 30%(1277/4228) had peptic ulcer disease (PUD), 9%(417/4228) had varices, and 27%(1135/4228) received endoscopic therapy. Reasons for no endoscopy (n=873) were: 56%(n=491) not clinically indicated/27%(n=234) outpatient procedure /18%(n=156) not for active treatment /7%(n=64) self-discharged /1%(n=7) transferred to other hospital /6%(n=51) death. 10% (416/4228) had evidence of further in-patient bleeding after index endoscopy. 9%(440) underwent>1 endoscopy during inpatient stay; 0.8%(n=42) underwent surgery, 2.6%(n=134) had interventional radiology (IR) and 49%(n=2511) were transfused≥1 packed red blood cells; 4%(n=212) platelets; and 5%(n=282) fresh frozen plasma for AUGIB. Median length of stay was 5 days (IQR 3-9). In-hospital mortality was 9%(n=461); 5.7% in new admissions and 18.4% in inpatients. Comparisons with the 2007 audit revealed significant differences in patient profiles in 2022, including an increase in comorbid patients (67% vs 50%), higher prevalence of anticoagulant use (31% vs 13%), and a greater proportion with underlying CLD (17% vs 9%). A higher percentage of patients underwent inpatient endoscopy (83% vs 74%) in 2022, with reductions in PUD (30% vs 36%) and varices (9% vs 11%). There was a significant increase in those receiving endotherapies (27% vs 24%) and undergoing IR procedures (2.6% vs 1.2%), along with a lower likelihood of further in-patient bleeding after an index endoscopy (10% vs 13%), surgery (0.8% vs 1.9%), and in-hospital mortality (9% vs 10%). All differences were found to be statistically significant (p<0.05). <br> <strong>Conclusions:</strong> Despite a more co-morbid population, there was reduced recurrent bleeding, need for surgery and in-hospital mortality for AUGIB since 2007. These improvements may be associated with improved management and better endoscopic therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".