Korean J Intern Med.  2019 Mar;34(2):288-295. 10.3904/kjim.2016.406.

Predictors for the need for endoscopic therapy in patients with presumed acute upper gastrointestinal bleeding

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. sgun9139@gmail.com

Abstract

BACKGROUND/AIMS
Selecting patients with an urgent need for endoscopic hemostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding.
METHODS
The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled patients' medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comorbidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment.
RESULTS
A total of 613 patients were analyzed, including 329 patients in the endoscopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p < 0.0001) and a hemoglobin level less than 8.6 g/dL (AOR, 1.768; 95% CI, 1.028 to 3.039; p = 0.039) were independent predictors for endoscopic hemostasis. Significant differences in the morbidity rates of endoscopic hemostasis were detected between the group with no predictive factors and the group with one or more predictive factors (OR, 2.677; 95% CI, 1.920 to 3.733; p < 0.0001).
CONCLUSIONS
A bloody nasogastric lavage and hemoglobin < 8.6 g/dL were independent predictors of endoscopic hemostasis in patients with acute upper gastrointestinal bleeding.

Keyword

Gastrointestinal hemorrhage; Hemostasis, endoscopic; Risk factors; Gastric lavage

MeSH Terms

Comorbidity
Demography
Gastric Lavage
Gastrointestinal Hemorrhage
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Humans
Medical Records
Mortality
Multivariate Analysis
Odds Ratio
Risk Factors
Therapeutic Irrigation
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