title: Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: implications for early discharge?
abstract: BACKGROUND
  There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding.
  
  
  OBJECTIVE
  Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death).
  
  
  METHODS
  Secondary analysis of two prospective multicenter studies. Multivariate analyses for each investigated outcome were performed; a single model was developed including all factors that were statistically significant in each sub-model. A final score was developed to predict favourable outcomes. Prognostic accuracy was tested with ROC curve analysis.
  
  
  RESULTS
  Out of 2398 patients, 211 (8.8%) developed one or more adverse outcomes: 87 (3.63%) had rebleeding, 46 (1.92%) needed surgery and 107 (4.46%) died. Predictors of favourable prognosis were: ASA score 1 or 2, absence of neoplasia, outpatient bleeding, use of low-dose aspirin, no need for transfusions, clean-based ulcer, age <70 years, no haemodynamic instability successful endoscopic diagnosis/therapy, no Dieulafoy's lesion at endoscopy, no hematemesis on presentation and no need for endoscopic treatment. Overall prognostic accuracy of the model was 83%. The final score accurately identified 20-30% of patients that eventually do not develop any negative outcome.
  
  
  CONCLUSIONS
  The "good luck score" may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding.
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy. Electronic address: gianluca.rotondano@virgilio.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rotondano
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Cipolletta
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy; Gastroenterology ACO San Filippo Neri, Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Koch
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Bianco
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy; Medical Department, Bracco, Milano, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Grossi
authors.affiliation: Gastroenterology Hospital Maresca, Torre del Greco, Italy; Gastroenterology Hospital Curto, Polla, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D013272:Stomach Diseases / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Adverse outcomes; Early discharge; Gastrointestinal bleeding; Prediction rule; Risk assessment