[Multivariate analysis of the risk of hemorrhagic recurrence in gastroduodenal ulcer. Study of a prospective series].
OBJECTIVE
To construct a model to enable calculation of rebleeding risk in patients admitted to a hospital emergency department with upper gastrointestinal bleeding secondary to a gastric or duodenal ulcer.


METHODS
We analyzed 317 patients admitted during a 13-month period with an episode of upper gastrointestinal bleeding secondary to a gastroduodenal ulcer. The patients were followed-up for 30 days after discharge. Uni- and multivariate analysis of the clinical and endoscopic variables was performed on variables that could be associated with an increased risk of rebleeding.


RESULTS
In the univariate analysis the following variables were significantly associated with an increased risk of rebleeding: the presence of blood in the endoscopically examined tract (p < 0.0001), clean ulcer base (p < 0.0001), low blood flow (p < 0.047) and size of the ulcer > 2 cm (p < 0.004). Independent risk variables identified by multivariate logistic regression analysis were low cardiac output, the presence of blood in the endoscopically examined tract, size of the ulcer, and type of ulcer base.


CONCLUSIONS
Patients with a clean ulcer base, smaller than 2 cm, without blood in the endoscopically examined tract and with stable hemodynamics were at very low risk of rebleeding and could be discharged directly from the emergency room.
Vidal Puigserver
J
J
Servicio de Urgencias y Servicio de Digestivo, Hospital Son Dureta, Palma de Mallorca.
Pagán Pomar
A
A
Rua García
A
A
Sapiña
A
A
Obrador Adrover
A
A
D000704:Analysis of Variance; D003657:Decision Making; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D005773:Gastroscopy; D006760:Hospitalization; D006801:Humans; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000150:complications* / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012306:Risk; D013997:Time Factors