Analysis of Risk Factors Related to Death from Acute Upper Digestive Tract Hemorrhage in Athletic Patients and the Predictive Value of Different Scoring Systems on the Risk of Death

Abstract

Objective: To investigate the risk factors associated with mortality in athletic patients experiencing acute upper gastrointestinal bleeding (AUGIB), focusing on the athletic population, and to evaluate the predictive accuracy of various scoring systems for mortality risk. Methods: From May 2019 to May 2022, 640 athletic patients with AUGIB, including athletes, were treated at our hospital and subsequently included in this study. These athletic patients were divided into two groups: those who died (n=135) and those who survived (n=505). Clinical characteristics and outcomes were compared between the two groups. Logistic regression analysis was used to identify risk factors for mortality, and the receiver operating characteristic (ROC) curve was utilized to assess the predictive value of endoscopic jet hemorrhage, shock presence, AIMS65 score system, and Full Rockall Score (FRS) in determining the risk of death. Results: There were no significant differences between the death and survival groups regarding age, body mass index, sex, smoking history, drinking history, previous bleeding episodes, or education level (P>0.05). The incidence of hematemesis was significantly higher in the death group (P<0.05). Factors such as bleeding diameter >2.0cm, initial symptom presentation, and etiology of bleeding did not differ significantly (P>0.05). However, indicators such as hemoglobin <90g/L, hematocrit <25%, platelet count ≤10×10^9/L, rebleeding, endoscopic jet-like bleeding, coexisting organ diseases, and shock at presentation were significantly more common in the death group (P<0.05). Additionally, levels of blood urea nitrogen, as well as scores for GBS, AIMS65, and FRS, were significantly higher in the death group (P<0.05). Multiple regression analysis revealed that factors including hemoglobin <90g/L, hematocrit <25%, platelet count ≤10×10^9/L, rebleeding, jet-like bleeding under endoscopy, coexisting organ diseases, elevated blood urea nitrogen levels, high GBS, AIMS65, FRS scores, and shock were independent risk factors for mortality (P<0.05). Pearson correlation analysis showed significant associations between FRS score, AIMS65 score, shock, and endoscopic jet bleeding with AUGIB mortality (P<0.05). The area under the curve (AUC) for predicting AUGIB mortality using the FRS score, AIMS65 score, shock presence, and endoscopic jet bleeding were 0.862, 0.719, 0.654, and 0.735, respectively. Conclusion: In athletic patients with AUGIB, including athletes, the FRS score, AIMS65 score, shock, and endoscopic jet bleeding are significant predictors of mortality, with the FRS score demonstrating the highest predictive value. This underscores the importance of these factors in assessing mortality risk and guiding clinical decision-making for athletic patients with AUGIB.