Acute upper gastrointestinal bleeding: a population-based cohort study from Southern Iceland

BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a common reason for emergency room presentation and can cause significant morbidity and mortality. Most studies only describe outcomes among admitted individuals. The aim of the study was to evaluate incidence, outcomes, and prediction model usage for all AUGIB presentations at Landspitali University Hospital, Iceland regardless of hospital admission. METHODS: A retrospective chart review was performed on all visits to Landspitali 2017-2023 with ICD-10 codes indicating UGIB. AUGIB incidence was calculated for individuals who resided in the hospital's catchment area and analyzed using Poisson regression. Characteristics upon presentation, endoscopy results and outcomes were collected. Survival analysis was performed with the Kaplan-Meier method. RESULTS: During the study period, 1129 AUGIB cases occurred among 1017 individuals. At first presentation, mean age was 60.0 years, 376 (37%) were females, and 685 (67%) were admitted. Overall, annual AUGIB incidence was 75/100,000, with incidence of admitted cases 51/100,000, both decreased over the study period. Admitted patients were more likely to undergo endoscopy (661 [96%] vs 218 [66%], OR 14.4 95%CI 9.04-23.0) and receive blood transfusions (424 [62%] vs 3 [0.9%], OR 178 95%CI 56.6-561). Thirty-day all-cause mortality was 6.7% (95%CI 4.8%-8.6%) for admitted and 0.9% (95%CI 0%-1.9%) for non-admitted cases, OR 7.89 (95%CI 2.44-25.6). The Glasgow-Blatchford score was reported in 1% of cases. DISCUSSION: AUGIB incidence in Iceland was low and appeared to be decreasing. A substantial proportion of patients were not admitted. Triage was excellent despite limited prediction model usage, as intervention was rare among discharged individuals.