title: Chronic kidney disease, hemodynamic instability, and endoscopic high-risk appearance are associated with 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding.
abstract: The results of studies that evaluated predictive factors for rebleeding in non-variceal upper gastrointestinal bleeding are inconsistent. The aim of this study was to investigate predictive factors for 30-day rebleeding in these patients. A consecutive 312 patients presenting symptoms and signs of gastrointestinal bleeding were enrolled in this prospective, observational study. Clinical and demographic characteristics and endoscopic findings were evaluated for potential factors associated with 30-day rebleeding using logistic regression analysis. Overall, 176 patients were included (male, 80.1%; mean age, 59.7±16.0 yr). Rebleeding within 7 and 30 days occurred in 21 (11.9%) and 27 (15.3%) patients, respectively. We found that chronic kidney disease (CKD) (OR, 10.29; 95% CI, 2.84-37.33; P<0.001), tachycardia (pulse>100 beats/min) during the admission (OR, 3.79; 95% CI, 1.25-11.49; P=0.019), and Forrest classes I, IIa, and IIb (OR, 6.14; 95% CI, 1.36-27.66; P=0.018) were significant independent predictive factors for 30-day rebleeding. However, neither Rockall nor Blatchford scores showed statistically significant relationships with 30-day rebleeding in a multivariate analysis. CKD, hemodynamic instability during hospitalization, and an endoscopic high-risk appearance are significantly independent predictors of 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. These factors may be useful for clinical management of such patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Lee
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kim
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Hah
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Park
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.forename: Byoung Kuk
authors.initials: BK
authors.lastname: Jang
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Chung
authors.forename: Jae Seok
authors.initials: JS
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index; D013610:Tachycardia / Q000150:complications
keywords: Kidney Failure, Chronic; Nonvariceal Upper Gastrointestinal Bleeding; Predictive Factors; Rebleeding