Predictors of In-Hospital Mortality in Helicobacter pylori–Negative, Non-Variceal Upper Gastrointestinal Bleeding: A Retrospective Cohort Study

Giselle María Padilla Gutiérrez,1 Gregorio Jurado Delgado,1 Alex Domínguez-Vargas,2 Natalia Andrea Jurado Rua,3 Leonardo F Brochado Fontalvo,1,4 Henry J González-Torres1,2 1Faculty of Health Sciences, Center for Life Sciences Research, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia; 2Data Analysis and Mining Department, D&P Consulting Service SAS, Barranquilla, Atlántico, Colombia; 3Faculty of Health Sciences, Universidad Libre, Barranquilla, Atlántico, Colombia; 4Department of Internal Medicine, Clínica de la Costa, Barranquilla, Atlántico, ColombiaCorrespondence: Henry J González-Torres, Faculty of Health Sciences, Center for Life Sciences Research, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia, Email [email protected]: With the global decline in Helicobacter pylori infection, upper gastrointestinal bleeding (UGIB) is increasingly driven by non-infectious, non-Nonsteroidal Anti-Inflammatory Drug (NSAID) mechanisms, particularly antithrombotic use and comorbidity-related mucosal injury. This study aimed to characterize the etiology, clinical profile, and in-hospital mortality predictors in patients with H. pylori-negative, non-variceal UGIB in a Colombian tertiary care setting.Patients and Methods: We conducted a retrospective cohort study at a quaternary hospital in Barranquilla, Colombia, including all adults (≥ 18 years) hospitalized with endoscopically confirmed non-variceal UGIB and negative H. pylori testing (rapid urease test and/or histology). Clinical, endoscopic, and medication data were analyzed.Results: Of 285 patients, the median age was 60 years (IQR: 39– 73), and 54% were male. NSAID use was rare (2.8%), whereas antithrombotic exposure was prevalent (28.8%), including low-dose aspirin (18.2%) and dual antiplatelet therapy (4.9%). The most common endoscopic findings were erosive gastropathy (45%) and ulcers (12%). Overall in-hospital mortality was 5% (n=13). In multivariable analysis, age > 60 years (aOR: 2.9; 95% CI: 1.7– 10.2; p = 0.05), cardiovascular complications (aOR: 7.8; 95% CI: 1.9– 32.0; p = 0.004), encephalopathy (aOR: 8.5; 95% CI: 2.2– 33.0; p = 0.009), and antiplatelet plus anticoagulant therapy (aOR: 5.3; 95% CI: 1.6– 17.5; p = 0.006) were independently associated with in-hospital mortality.Conclusion: In this cohort, in-hospital mortality in non-variceal UGIB patients without H. pylori infection was associated with systemic factors such as advanced age, cardiovascular complications, encephalopathy, and antiplatelet–anticoagulant combination therapy rather than bleeding lesions. These findings support risk stratification based on comorbidities and medication use in this growing population.Keywords: upper gastrointestinal bleeding, Helicobacter pylori, in-hospital mortality, anticoagulant therapy, melena, hematemesis