Clinical predictors of outcome in acute upper gastrointestinal bleeding.
OBJECTIVE
Endoscopy has traditionally been used to risk-stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful recovery.


METHODS
Prospective, descriptive cross-sectional study.


METHODS
Groote Schuur Hospital, Cape Town.


METHODS
Two hundred consecutive patients aged over 12 years, presenting with haematemesis and/or melaena.


METHODS
Good outcome, i.e. no blood transfusion, endotherapy or surgery, and alive at 1 month following presentation.


RESULTS
Eighty patients (40%) had a good outcome. Haemoglobin > 10 g/dl (odds ratio (OR) 25.5, 95% confidence interval (CI): 8.9-74.8; p < 0.001), absence of melaena (OR 4.8, 95% CI: 1.79-12.94, p = 0.002) and absence of syncope (OR 4.0, 95% CI: 1.67-9.48; p = 0.002) were independent predictors of good outcome. The three variables combined as a positive test had the best association with good outcome when compared with a single variable or a combination of two variables. The three-variable model had sensitivity for good outcome of 34%, specificity of 98%, and likelihood ratio for a positive test of 13.5 and for a negative test of 0.68. Thirty patients (15%) had the combination for the prediction rule, i.e. haemoglobin > 10 g/dl, no melaena and no syncope; 3 (10%) had a poor outcome (required endotherapy).


CONCLUSIONS
The prediction rule accurately excluded poor outcome, a priority in the clinical context, but did not predict good outcome. Clinical implications are a 15% reduction in unnecessary urgent endoscopies, with less than 5% of patients with poor outcome not undergoing urgent endoscopy. These findings may have particular clinical relevance in under-resourced health care environments.
Kalula
S Z
SZ
Division of Geriatrics, Department of Medicine, University of Cape Town.
Swingler
G H
GH
Louw
J A
JA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003663:Decision Trees; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa; D013575:Syncope / Q000209:etiology; D016896:Treatment Outcome
D006454:Hemoglobins