Risk assessment of Rebleeding and Mortality after Acute Upper Gastrointestinal Bleeding through Clinical Manifestations

ABSTRACT

PURPOSE: Upper gastrointestinal bleeding (UGIB) is an urgent medical condition that emergency medicine doctors commonly encounter in the emergency room (ER). Initial management and triage of UGIB patients depend on nonendoscopic findings, so we sought risk factors for UGIB patients by using only the initial clinical data and the patient's condition in the ER. METHODS: By reviewing the data of 302 patients with the impression of UGIB between January of 1998 and December of 2000, the authors attempted to predict risk factors related to rebleeding, mortality, and need for surgical treatment. Based on blood analysis, physical exam, and history taking performed at the ER, the authors conducted a retrospective study in order to determine factors which influence rebleeding and overall mortality. RESULTS: From the blood pressure, pulse rate, and blood analysis taken at the time of admission, the levels of hemoglobin and hematocrits were shown to be related to rebleeding (p<0.05). If there was on-going bleeding, the relative risk of rebleeding was 2.314 times (p=0.023), and if the hemoglobin value was under 8 gm/dL, relative risk of rebleeding was 6.809 times (p=0.000). The factors which influenced the overall mortality rate were the blood pressure measured at the time of admission (p=0.001), the presence of on-going bleeding and rebleeding (p=0.000), and the level of hemoglobin, hematocrits and creatinine (p=0.001). A logistic regression analysis showed that when there was on-going bleeding, the relative risk of the mortality was 10.4 times (p=0.000) and when there was a high creatinine level, it was 7.8 times (p=0.001) CONCLUSION: When a patient with UGIB reports to the ER and shows unstable vital signs, a low hemoglobin level, and evidence of on-going bleeding, one should perform gastroendoscopy as soon as possible, and a need exists for aggressive treatment, even after admission.