Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Abstract

AIM:To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score. METHODS:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS:Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION:The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

The clinical significance of upper gastrointestinal bleeding etiology score in determining variceal bleeding

“…The overall diagnostic accuracy of UGIB score in the current study was 80.2%. Pongprasobchai and colleagues reported a somewhat similar validity of the UGIB etiology score in their study: while keeping the cut off value of ≥3.1 as positive; they reported sensitivity, specificity, positive predictive value and negative predictive values of 85%, 82%, 50% and 96%, respectively [11]. The overall diagnostic accuracy was comparable with our study, at 81% [11].…”

“…It has been reported previously that UGIB patients are predominantly male (ranging between 60% -80%) [11,12], and comparably, in our study, we found that 56% of all patients were male.…”

“…Pongprasobchai et al [11] showed in their study that the average age for UGIB was 53 years for variceal bleeding, and 61 years for non-variceal bleeding. Likewise, Tammaro L. et al [12] also revealed an older age of their patients; the mean age of their patients was 65 years.…”

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

“…It is important to predict the cause of bleeding prior to endoscopy, as the procedure of endoscopic hemostasis or the prognosis varies depending on whether the cause of bleeding is variceal or non‐variceal. According to studies concerning the prediction of the cause of bleeding, past history of liver cirrhosis or variceal bleeding, heavy drinking, presence of ascites, thrombocytopenia, hyperbilirubinemia, or elevation of prothrombin time–international normalized ratio (PT‐INR) is associated with variceal bleeding, whereas dosage of antiplatelet or anticoagulant drug is associated with non‐variceal bleeding such as hemorrhagic gastroduodenal ulcer . Moreover, among patients with chronic liver disease or cirrhosis, patients with higher spleen diameter (platelet/spleen diameter ratio) and worse Child–Pugh score were reported to have a higher risk of variceal bleeding .…”

Mortality In Geriatric Patients With Upper Gastrointestinal Bleeding

“…Asit baskılayıcı tedavileri kullanma sıklığında artış ve başarılı endoskopik girişimlerin geliştirilmesine rağmen mortalite oranları hala yüksektir. Farklı kaynaklarda mortalite %5-15 arasında bildirilmektedir (4,5). Ülkemizin de içinde bulunduğu Doğu Akdeniz ülkelerinde maalesef mortalite henüz istenen düzeye ulaşamamıştır.…”