Pre-endoscopic prognostic factors in non-varicose upper gastrointestinal bleeding. Development of a predictive algorithm.

Abstract

OBJECTIVE:

Upper gastrointestinal or digestive bleeding (UDB) is a common problem requiring hospitalization and implying important morbidity-mortality. The aim of the present study is to identify clinical and laboratory factors predictive of a serious course of non-varicose UDB, based on the development of a simple algorithm for application in the clinical setting.

METHODS:

A longitudinal study was made of 803 hospitalized patients with non-varicose UDB. Clinical and laboratory parameters were recorded in the Emergency Service before endoscopy. A first non-conditional logistic regression model was developed, including those variables exhibiting a greater capacity for predicting a serious outcome. This model was posteriorly simplified to facilitate clinical application. The prognostic performance was estimated by calculating the area under the ROC curve.

RESULTS:

The initial predictive model included 11 variables, with an area under the ROC curve of 0.74 (95%CI: 0.71-0.77), while in the second model these same variables were dichotomized, exhibiting an area under the ROC curve of 0.74 (95%CI: 0.70-0.77). Based on the corresponding regression coefficients, the prognostic variables were classified as either major (shock, liver disease, anticoagulant therapy, urea/creatinine ratio > 62) or minor (hematocrit < 33%, renal failure, presentation as hematemesis and melenas, systolic arterial pressure < 110 mmHg, regular alcohol consumption, a history of UDB, and a patient age of > 75 years). UDB was predicted to take an unfavorable course in the presence of one major factor or two minor factors.

CONCLUSIONS:

The proposed algorithm includes pre-endoscopy clinical and laboratory variables, and allows early classification of patients with non-varicose UDB in terms of their possible clinical course.

• Authors: A Zaragoza Marcet, J M Tenías Burillo, M J Llorente Melero
• Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva (Rev Esp Enferm Dig) Vol. 94 Issue 3 Pg. 139-48 (Mar 2002) ISSN: 1130-0108 [Print] Spain
• PMID: 12185878 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Age Factors
• Aged
• Algorithms
• Female
• Gastrointestinal Hemorrhage (diagnosis)
• Humans
• Logistic Models
• Longitudinal Studies
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Risk Factors