EARLY INDICATORS OF PROGNOSIS IN UPPER GASTROINTESTINAL HEMORRHAGE

Objective: Endoscopy allows accurate risk stratification of patients p resenting with gastrointestinal bleeding; frequently, however, it is n ot immediately available, Initial management and triage of patients th us depends on nonendoscopic information. We sought to risk stratify pa tients with upper gastrointestinal bleeding using variables available on initial presentation (i,e,, before endoscopy). Methods: A retrospec tive observational study was performed using data from 335 admissions with an initial diagnosis of upper gastrointestinal hemorrhage, All pa tients underwent endoscopy and were evaluated for an adverse outcome d uring their hospitalization. An adverse outcome was defined as death, the need for any operation, recurrent hematemesis, recurrent melena af ter initial clearing, or a hematocrit falling despite transfusion. Res ults: Univariate analysis identified 17 distinct variables associated (p < 0.05) with an adverse outcome. A stepwise logistic regression ide ntified five variables as independent predictors (p < 0.05) of an adve rse outcome: an initial hematocrit <30%, initial systolic blood pressu re < 100 mm Hg, red blood in the nasogastric lavage, history of cirrho sis or ascites on exam, and a history of vomiting red blood. We derive d a decision rule based on patients having 0-5 of these independent pr edictors, This decision rule allowed identification of a large patient population with a <10% chance of an adverse outcome. Conclusion: Risk stratification is possible from information available at the time of initial presentation. If confirmed in other populations, these predict ors can be used to identify patients who require a less intensive leve l of care. (C) 1998 by Am. Coll. of Gastroenterology.