PREDICTION OF FURTHER HEMORRHAGE IN BLEEDING PEPTIC-ULCER

Objective: To obtain a simple mathematical model able to estimate earl y the risk of further hemorrhage in bleeding peptic ulcer. Methods: A prospective study was conducted on 1567 patients admitted for acutely bleeding peptic ulcer. Ten readily available variables were tested for association with further hemorrhage, and then a logistic regression a nalysis was carried out. Results: Further hemorrhage occurred in 312 ( 20%) patients. The univariate analyses showed age over 65 yr, male sex , alcoholism, associated disease, hematemesis, endoscopic bleeding sti gmata and shock, and blood urea over 90 mg/dl at admission to be signi ficantly associated with continuous hemorrhage or rebleeding (p < 0.05 to p < 0.001). When these were assessed in a multivariate logistic re gression analysis, the best fitted model (likelihood ratio test = 9.9; p = 0.5) included four independent variables. Bleeding stigmata (p < 0 .001; odds ratio = 3.1), shock (p < 0.001, odds ratio = 2.5), hemateme sis (p < 0.001; odds ratio = 1.6) and age over 65 (p = 0.04); odds rat io = 1.3) were associated with high risk of further hemorrhage. Conclu sions: Bleeding stigmata and changes in hemodynamics are confirmed as the most relevant predictors of further hemorrhage. When they are cons idered with hematemesis and age altogether, other clinical features lo ss importance for prognosis. By taking advantage of the joint influenc es of these variables, accuracy of prognosis improves with respect to that obtained when they are considered as individual risk factors.