Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding

Abstract

Background Rebleeding is associated with poor outcomes in upper gastrointestinal bleeding (UGIB). Identifying predictors of rebleeding can assist in risk assessment. The aim of the study is to investigate the factors affecting rebleeding in patients with UGIB admitted to the emergency department. Methods This retrospective, observational, cross-sectional study was conducted on patients with UGIB presented to the emergency department. Patients who did not arrest in the first 24 h, who were not diagnosed with GI malignancy, and who were clinically diagnosed with UGIB were included in the study. Patient demographic characteristics, hemodynamic parameters, patient parameters, and bleeding that may affect rebleeding were evaluated. The primary endpoint was rebleeding within 7 days. Results The study included 371 patients. A total of 55 patients (14.8%) had rebleeding within 7 days, and 62 patients (16.7%) presented without bleeding manifestations. Rebleeding rates were higher in those who presented with bloody or coffee-ground vomitus, had a diagnosis of cancer, had blood in their nasogastric tube, and had peptic ulcers due to endoscopy. Mean cell hemoglobin concentration, lymphocyte, albumin, and total protein values of patients with rebleeding were low; red blood cell distribution width, neutrophil count, platelet distribution width (PDW), and neutrophil lymphocyte ratio were high. In-hospital mortality and 30-day mortality values of patients with rebleeding were significantly increased. In the multivariate analysis, cancer, PDW, and total protein levels were statistically significant. Conclusion The presence of cancer, low total protein level, and high PDW are effective parameters in predicting 7-day rebleeding in patients with UGIB admitted to the emergency department.

Analysis of the diagnostic utility of Glasgow-Blatcford Score, Rockall Score, AIMS65 Score, BUN-to-albumin ratio and BUN-to-creatinine ratio for predicting the need for transfusion in upper gastrointestinal bleeding

“…Based on the literature, this rate seems to be lower than that reported in previous studies (16,19). However, when the average age of our participants is examined, it is also noted that this average is lower than that in the literature (5,12). Nevertheless, as in previous studies, the average age of transfused patients was significantly higher than that of the nontransfused group (14,20).…”

“…A poor outcome has been associated with hemodynamic instability and signs of perfusion impairment, as well as advanced age in previous studies (15). Factors associated with rebleeding include active bleeding during endoscopy, large ulcerations, and low pre-albumin and high D-dimer levels (5,12). Meanwhile, cancer, low hemoglobin levels at presentation, and a transfusion requirement are associated with both rebleeding or ongoing bleeding and mortality (16)(17)(18).…”

“…Risk scores such as Glasgow-Blatchford score (GBS), Rockall score, and AIMS65 score are primarily used to predict poor outcomes (2)(3)(4). In spite of this, the changing etiologic factors in UGIB and the favorable effect of mortality improvements indicate that it is not a single condition (5).…”