title: Clinical and endoscopic signs for the prediction of recurrent bleeding from gastroduodenal ulcers.
abstract: OBJECTIVE
  To evaluate the prognostic importance of various clinical and endoscopic signs in patients who rebled after endoscopic treatment of gastroduodenal ulcers, and to create a predictive index using regression analysis.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Teaching hospital, Lithuania.
  
  
  METHODS
  659 patients whose bleeding peptic ulcers were treated endoscopically (out of a total of 949 with bleeding peptic ulcers seen from 1982-1991).
  
  
  METHODS
  Endoscopic haemostasis (laser or electrocoagulation, or injection sclerotherapy).
  
  
  METHODS
  Mortality, incidence of rebleeding, and identification of prognostic factors.
  
  
  RESULTS
  Of the 75 patients who rebled 25 died (33%), compared with 23 of the 584 who did not (4%). 57 patients (76%) rebled within two days of endoscopy, and 70 (94%) within a week. 59 variables from the group of 75 who rebled and from a control group of 100 who did not were analysed by logistic regression to construct a predictive index. The following 12 variables were found to be significantly associated with recurrent haemorrhage: frequency and type of bleeding; length of time between episodes of bleeding at home; shock index on admission; speed of reduction in haemoglobin concentration; size and type of ulcer, and whether it was complicated; endoscopic appearance of ulcer; number of ulcers, sex of the patient, and presence of associated diseases (liver disease, coagulopathy, hypertension, or heart disease). The accuracy of the index varied from 78.4% in the prediction of a high risk of rebleeding to 100% in the prediction of a low risk.
  
  
  CONCLUSIONS
  By using the predictive index we have been able to improve our management of patients with bleeding peptic ulcers.
authors.affiliation: General Surgery Department, Kaunas Medical Academy, Lithuania.
authors.forename: J
authors.initials: J
authors.lastname: Pundzius
mesh_terms: D004381:Duodenal Ulcer / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D015911:Sclerotherapy; D013276:Stomach Ulcer / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome