JOURNAL ARTICLE

Upper gastrointestinal bleeding: predictors of risk in a mixed patient group including variceal and nonvariceal haemorrhage

Conor Lahiff, William Shields, Ion Cretu, Nasir Mahmud, Susan McKiernan, Suzanne Norris, Bernard Silke, John V Reynolds, Dermot O'Toole
European Journal of Gastroenterology & Hepatology 2012, 24 (2): 149-54
22113209

BACKGROUND AND STUDY AIMS: Effective management of upper gastrointestinal bleeding (UGIB) relies on the application of clinical risk scores. The validation of risk scores has to date focused mainly on nonvariceal UGIB groups. We aimed to evaluate our clinical and endoscopic management of UGIB, and to validate existing risk scores for a mixed patient population with a high percentage of variceal bleeds.

STUDY DESIGN AND METHODS: Analysis included UGIB patients presenting consecutively to a tertiary referral university hospital. All patients had been admitted by our emergency department and had undergone upper gastrointestinal endoscopy. Clinical, biochemical and endoscopic data were recorded. Clinical and complete Rockall and Blatchford risk scores were calculated for all patients and statistical analysis was carried out by a multiple logistical regression model.

RESULTS: A total of 21% of patients had variceal bleeds. There was considerable heterogeneity between groups with the variceal group having more comorbidities (P=0.003), lower haemoglobin (P=0.003) and lower systolic blood pressure (P=0.013) at presentation. This translated to higher risk scores (P<0.0001) and worse clinical outcomes (rebleeding P=0.004). Only complete Rockall score was predictive of outcome (rebleeding P=0.004, AUC 0.8). Blatchford score did not predict bleeding or mortality. However, no patient with a Blatchford score of 0 had an adverse clinical outcome.

CONCLUSION: Postendoscopic Rockall score can be used as a predictor of outcome for mixed UGIB groups. Although Blatchford score did not predict outcome in our study, at a 0 level it does appear to be a safe triage tool for pre-endoscopic identification of patients with variceal bleeds, even where there is no known history of liver disease.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
22113209
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"