Prognostic markers in upper gastrointestinal hemorrhage.

ABSTRACT

This study was undertaken to ascertain whether clinical and endoscopic factors can predict the outcome in patients with acute upper gastrointestinal hemorrhage. A total of 185 patients admitted with hematemesis over a 4-year period were studied. Clinical evidence of shock and hepatocellular dysfunction and hemoglobin level were noted on admission. Endoscopy was performed within 48 hours of admission to look for the site and number of lesions, and stigmata of hemorrhage. On analysis, age, clinical evidence of shock, hepatic dysfunction and hemoglobin less than 8.0 g/dl (80 g/L) were found to be significant in prediction of risk of further hemorrhage. Similarly age, past history of jaundice, previous bleeding episodes and clinical evidence of hepatic dysfunction were statistically significant predictors of mortality. Bleeding from varices and peptic ulcer was associated with a worse prognosis than acute mucosal lesions. It is concluded that clinical and endoscopic factors can be used to identify a group of patients at high risk of further hemorrhage and mortality.