Availability of Blood Urea Nitrogen/Creatinine Ratio in Gastrointestinal Bleeding with Melena in Children

Abstract

PurposeThe aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children.MethodsRetrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions.ResultsAmong the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group.ConclusionThe BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.

Diagnostic evaluation of urea nitrogen/creatinine ratio in dogs with gastrointestinal bleeding

“…This result is consistent with a study that found no significant difference in Hb between upper and lower GIB in children. 30 However, in contrast to our study, several other studies in people have found that Hb, Hct, or both were significantly decreased in patients with upper GIB compared to those with lower GIB. 5,7,31 In these studies, it was postulated that upper GIB was more severe than lower GIB, resulting in more severe blood loss.…”

“…In our study, Hb and Hct were not significantly different between dogs with upper and lower GIB. This result is consistent with a study that found no significant difference in Hb between upper and lower GIB in children 30 . However, in contrast to our study, several other studies in people have found that Hb, Hct, or both were significantly decreased in patients with upper GIB compared to those with lower GIB 5,7,31 .…”

“…[7][8][9][10][11] These contradictory results may be a result of differences in inclusion criteria. Many studies in humans included only patients with overt GIB, 6,7,[29][30][31] whereas both overt and occult GI bleeders were enrolled in our study. After controlling the type of GIB, an association between location of GIB and UCR was not identified in our study.…”

Profile of Acute Gastroenteritis in Children Under Five Years of Age, and Their Association With Blood Urea Nitrogen-to-Creatinine Ratio

“…A BCR ratio of more than 30:1 is used to differentiate upper GI bleed from lower GI bleed in children. 17,18 This is because the transit time is higher in upper GI bleed, allowing more time for absorption and catabolism. 19 BCR was found to be significantly associated with severity of dehydration.…”