ABSTRACT
Objective:Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal disease in the emergency department. Identifying low-risk patients suitable for outpatient treatment is the focus of clinical and research. A simple predictive model was developed to identify patients with UGIB who could safely avoid hospitalization, thus providing a feasible basis for triage by emergency physicians.Methods:A retrospective cohort study was conducted on patients with UGIB treated at Zhongda Hospital Southeast University from January 2015 to December 2020. Baseline demographic data and clinical parameters at the initial presentation were recorded. Multivariate logistic regression model was performed to identify predictors of safe discharge.Results:Six hundred and twelve patients (45.9%) were not safely discharged. There were significant differences in age, Charlson comorbidity index, systolic blood pressure, pulse rate, hemoglobin, albumin, blood urea nitrogen, creatinine and international normalized ratio between the safe discharge group and the non-safe discharge group ( P<0.05). Using multivariate logistic regression analysis, a total of 7 variables were included in the clinical prediction model of UGIB risk stratification: Charlson comorbidity index > 2, systolic blood pressure < 90 mmHg, hemoglobin < 10 g/dL, blood urea nitrogen ≥6.5 mmol/L, albumin <30 g/L, pulse ≥100 beats/min and international normalized ratio ≥1.5. The sensitivity, specificity, positive predictive value, and negative predictive value for predicting unsafe discharge were 98.37%, 24.10%, 52.3%, and 94.6%, respectively, with the best cutoff value ≥1. The area under the receiver operating characteristic (AUROC) curve was 0.822, which was significantly higher than Glasgow Blatchford score (GBS) 0.786 (95% CI: 0.752-0.820, P< 0.01) and AIMS65 0.676 (95% CI: 0.638-0.714, P< 0.01). Conclusions:The predictive model has a reliable predictive value, which can provide references for emergency medical staff to triage patients with UGIB, thereby reducing medical expenses and having certain social and economic benefits.
ABSTRACT
Background: Acute upper gastrointestinal bleeding (UGIB) is one of the most common medical emergencies and remains a major cause of morbidity and mortality. We are likely to see more of it in coming years with ageing population, patients with liver disease, increasing use of NSAIDs, single or multiple antithrombotic agents and novel anticoagulants, the present study was designed with the aim to assess the clinical profile of UGIB presenting to the Department of Medicine in sub Himalayan region.Methods: Study done over 12 months included all patients presenting with acute hematemesis and/or melena. Detailed history, clinical examination, blood tests and Upper GI Endoscopy was done in all patients.Results: One hundred seventy-five patients were included in the study, 129 (73.7%) were males. The commonest age group was 41-60 years contributing to 44%, male to female ratio 2.8:1. The commonest presentation was melena, patients with hematemesis presented earlier, with mean duration 1.46 days. 42.3% of patients were hemodynamically unstable at admission. The mean hemoglobin (Hb) was 8.224±2.78 g%. The cause of bleed was shared by ulcer, varices, non-ulcer non-variceal approximately 1/3rd each, major cause being ulcer in 39.4%. Varices was common in age 30-40 yrs, ulcer in age 51 to 70 years.Conclusions: UGI bleed was more frequent in males age between 41-60 yrs, peptic ulcer being the leading cause in our study, presence of signs of liver failure were associated with varices.