Peptic ulcer bleeding patients with Rockall scores 6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study

Background and AimPatients with high Rockall scores have increased risk of rebleeding and mortality within 30days after peptic ulcer bleeding, but long-term outcomes deserve follow-up after cessation of proton pump inhibitors. The paper aimed to validate whether patients with high Rockall scores have more recurrent ulcer bleeding in a 3.5-year longitudinal cohort. MethodsBetween August 2011 and July 2014, 368 patients with peptic ulcer bleeding were prospectively enrolled after endoscopic hemostasis to receive proton pump inhibitors for at least 8 to 16weeks. These subjects were categorized into either a Rockall scores 6 group (n=257) or a Rockall scores <6 group (n=111) and followed up until July of 2015 to assess recurrent ulcer bleeding. ResultsThe proportion of patients with rebleeding during the 3.5-year follow-up was higher in patients with Rockall scores 6 than in those with scores <6 (10.51 vs. 3.63 per 100person-year, P=0.004, log-rank test). Among patients with Rockall scores 6, activated partial thromboplastin time prolonged 1.5-fold (P=0.045), American Society of Anesthesiologists physical status class III (P=0.02), and gastric ulcer (P=0.04) were three additional independent factors found to increase rebleeding risk. The cumulative rebleeding rate was higher in patients with Rockall scores 6 with more than or equal to any two additional factors than in those with fewer than two additional factors (15.69 vs. 7.63 per 100person-year, P=0.012, log-rank test). ConclusionsPatients with Rockall scores 6 are at risk of long-term recurrent peptic ulcer bleeding. The risk can be independently increased by the presence of activated partial thromboplastin time prolonged 1.5-fold, American Society of Anesthesiologists class III, and gastric ulcer in patients with Rockall scores 6.