Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage.
OBJECTIVE
We assessed the predictive value of fibrinolytic tests for hospital outcome in a prospective study of 84 nonconsecutive patients with acute upper gastrointestinal hemorrhage.


METHODS
Six readily available parameters of activated fibrinolysis (fibrinogen, D-dimer, tissue plasminogen activator [TPA], plasminogen activator inhibitor type 1 [PAI-1], TPA--PAI-1 complexes, and plasmin-alpha 2-antiplasmin complexes) were tested for association with hospital outcome. Patients were divided into the following three groups: patients who survived and did not require transfusion or surgery, those who survived without surgery but required transfusion, and those who required surgery or died.


RESULTS
Patients with adverse outcome (surgery and/or death) showed significantly higher plasma levels of D-dimer than patients with favorable outcome (p = 0.01). Plasma concentrations of D-dimer >300 ng/mL showed a 20.5% positive predictive value of adverse outcome, with a relative risk of 7.5 (95% CI: 1--57%). Patients who required transfusion showed significantly higher plasma levels of TPA (p = 0.01). A positive correlation between endoscopic bleeding stigmata and D-dimer in the subgroup of patients without liver cirrhosis was found (p = 0.02); however, in the multivariate logistic regression analysis the concentration of D-dimer did not appear as an independent predictor of adverse outcome.


CONCLUSIONS
These findings are consistent with the role of increased local fibrinolysis in the digestive tract, particularly of D-dimer, in patients with upper gastrointestinal hemorrhage and adverse outcome. Accordingly, plasma fibrinolytic tests may constitute an appropriate prognostic marker in upper gastrointestinal bleeding.
Department of Internal Medicine, Hospital General Universitario, Universidad Miguel Hernández, Alicante, Spain.
A
A
Gutiérrez
J
J
Sánchez-Payá
P
P
Marco
M
M
Pérez-Mateo
D000368:Aged; D001780:Blood Coagulation Tests; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D006471:Gastrointestinal Hemorrhage / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D