Early Clinical Signs Identify Low-Risk Patients With Acute Upper Gastrointestinal Hemorrhage

Abstract

Early identification of patients at low risk for poor outcome after acute upper gastrointestinal hemorrhage would allow reduction of diagnostic and therapeutic interventions. We identified six early predictors of good outcome: age less than 75 years, no unstable comorbid illness, no ascites found on physical examination, normal prothrombin time, and, within an hour after presentation, systolic blood pressure of 100 mm Hg or greater and nasogastric aspirate free of fresh blood. Presence of all six predictors defined the low-risk population. Among 162 patients in the development and retrospective validation phases of our study, all 74 low-risk patients had good outcomes. A prospective validation study of 111 patients further established the accuracy of our predictive method; only two of 52 low-risk patients had poor outcomes. Application of our method should allow more selective management of patients with acute upper gastrointestinal hemorrhage.

Risk Assessment and Outpatient Management in Bleeding Peptic Ulcer

“…10,11,13,24,26,29,30 The percentage of patients classified as low risk and, therefore, candidates for outpatient management, oscillates between 8% and 50%, but in most cases it is around 25%. 12,[29][30][31][32][33] If predictive variables obtained in the multivariate analysis had been used (blood pressure $100 mm Hg, heart rate #100 bpm, and Forrest IIc or III ulcer), hospitalization could have been prevented in 115 patients (that is, in 34% of the cases).…”

“…34,35 Several studies have reported a low rebleeding rate in patients classified as low risk (and therefore candidates for immediate discharge), in some cases as low as 0%, as in our study. 29,32 Other authors have identified some episodes of rebleeding, but with an incidence around 1%. 10,12,13,26 Finally, although only in exceptional cases, some authors have reported slightly higher values, between 2% and 4%.…”

Impact of nasogastric lavage on outcomes in acute GI bleeding

“…11,26 The presence of blood in the NGL aspirate is predictive of poor outcomes. 24,[27][28][29] Adamopoulous et al 23 identified NGL blood as a strong independent predictor of active bleeding (OR 16.4; 95% CI, 4.8-56). Aljebreen et al 11 found that blood in the NGL aspirate correlated with finding high-risk lesions at the time of endoscopy.…”

Prediction scores in gastrointestinal bleeding: a systematic review and quantitative appraisal

“…Rockall [11] Marmo [14] Chiu [38] Guglielmi [35] Travis [26] Park [32] Blatchford [12] Bordley [30] Villanueva [28] Kollef [27] Corley [31] Strate [29] Almela [33] Imperiale [34] No. patients is indicated is actually difficult as outcomes largely differ; however, the Blatchford score [12] had the highest methodological quality and predictive power compared with the other scores.…”

“…Patients with a "good outcome" were defined as those alive, without persisting or recurrent bleeding, and patients who did not need surgery (• " Table 2) [30,31,33]. Consistent variables predicting good outcome included no co-morbid diseases, normal blood pressure, and no fresh blood after performing nasogastric aspiration (• " Table 3).…”