title: Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding.
abstract: OBJECTIVE
  The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification.
  
  
  METHODS
  Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary-outcome end-points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death).
  
  
  RESULTS
  One hundred and eighty-four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150 μm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver-operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60).
  
  
  CONCLUSIONS
  The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention.
authors.affiliation: Department of General Surgery, Chelsea & Westminster NHS Hospital Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Newman
authors.forename: J E F
authors.initials: JE
authors.lastname: Fitzgerald
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: A C
authors.initials: AC
authors.lastname: von Roon
authors.forename: H H
authors.initials: HH
authors.lastname: Sigurdsson
authors.forename: T G
authors.initials: TG
authors.lastname: Allen-Mersh
mesh_terms: D019540:Area Under Curve; D015897:Comorbidity; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012007:Rectum; D012017:Referral and Consultation; D012307:Risk Factors; D014218:Triage; D006113:United Kingdom / Q000453:epidemiology