Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding.
OBJECTIVE
To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.


METHODS
Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.


RESULTS
Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011). The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 x red vomitus) + (1.2 x red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff > or = 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score > or = 3.1 for variceal bleeding were 79% and 97%, respectively.


CONCLUSIONS
The UGIB Etiology Score, composed of 3 parameters, using a cutoff > or = 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.
Pongprasobchai
Supot
S
Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok 10700, Thailand. supotpong@hotmail.com
Nimitvilai
Sireethorn
S
Chasawat
Jaroon
J
Manatsathit
Sathaporn
S
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D014839:Vomiting / Q000209:etiology