title: Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding.
abstract: OBJECTIVE
  To investigate the early upper gastrointestinal endoscopy (endoscopy) significantly reduces mortality resulting from upper gastrointestinal (GI) bleeding.
  
  
  METHODS
  Upper GI bleeding was defined as 1a, 1b, 2a, and 2b according to the Forrest classification. The hemoglobin (Hb), and C-reactive protein (CRP) were examined at around the day of endoscopy and 3 mo prior to endoscopy. The rate of change was calculated as follows: (the result of blood examination on the day of endoscopy - the results of blood examination 3 mo prior to endoscopy)/(results of blood examination 3 mo prior to endoscopy). Receiver operating characteristic curves were created to determine threshold values.
  
  
  RESULTS
  Seventy-nine men and 77 women were enrolled. There were 17 patients with upper GI bleeding: 12 with a gastric ulcer, 3 with a duodenal ulcer, 1 with an acute gastric mucosal lesion, and 1 with gastric cancer. The area under the curve (AUC), threshold, sensitivity, and specificity of Hb around the day of endoscopy were 0.902, 11.7 g/dL, 94.1%, and 77.1%, respectively, while those of CRP were 0.722, 0.5 mg/dL, 70.5%, and 73%, respectively. The AUC, threshold, sensitivity, and specificity of the rate of change of Hb were 0.851, -21.3%, 76.4%, and 82.6%, respectively, while those of CRP were 0.901, 100%, 100%, and 82.5%, respectively.
  
  
  CONCLUSIONS
  Predictors for upper GI bleeding were Hb < 11.7 g/dL, reduction rate in the Hb > 21.3% and an increase in the CRP > 100%, 3 mo before endoscopy.
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tomizawa
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Fuminobu
authors.initials: F
authors.lastname: Shinozaki
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Rumiko
authors.initials: R
authors.lastname: Hasegawa
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Togawa
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Shirai
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Ichiki
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Motoyoshi
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sueishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015536:Down-Regulation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D006454:Hemoglobins / Q000378:metabolism*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D002097:C-Reactive Protein
keywords: Area under curve; Gastrointestinal bleeding; Receiver operating characteristic; Sensitivity; Specificity