Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage

Citation
A. Gutierrez et al., Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage, J CLIN GAST, 32(4), 2001, pp. 315-318
Citations number
10
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
JOURNAL OF CLINICAL GASTROENTEROLOGY
ISSN journal
01920790 → ACNP
Volume
32
Issue
4
Year of publication
2001
Pages
315 - 318
Database
ISI
SICI code
0192-0790(200104)32:4<315:PVOFTF>2.0.ZU;2-5
Abstract
Goals: We assessed the predictive Value of fibrinolytic tests for hospital outcome in a prospective study of 84 nonconsecutive patients with acute upp er gastrointestinal hemorrhage. Study: Six readily available parameters of activated fibrinolysis (fibrinog en, D-dimer, tissue plasminogen activator [TPA], plasminogen activator inhi bitor type 1 [PAI-1], TPA-PAI-1 complexes, and plasmin-alpha 2-antiplasmin complexes) were tested for association with hospital outcome. Patients were divided into the following three groups: patients who survived and did not require transfusion or surgery, those who survived without surgery but req uired transfusion, and those who required surgery or died. Results: Patients with adverse outcome (surgery and/or death) showed signif icantly higher plasma levels of D-dimer than patients with favorable outcom e (p = 0.01). Plasma concentrations of D-dimer >300 ng/mL showed a 20.5% po sitive predictive value of adverse outcome, with a relative risk of 7.5 (95 % CI: 1-57%). Patients who required transfusion showed significantly higher plasma levels of TPA (p = 0.01). A positive correlation between endoscopic bleeding stigmata and D-dimer in the subgroup of patients without liver ci rrhosis was found (p = 0.02); however, in the multivariate logistic regress ion analysis the concentration of D-dimer did not appear as an independent predictor of adverse outcome. Conclusions: These findings are consistent with the role of increased local fibrinolysis in the digestive tract, particularly of D-dimer, in patients with upper gastrointestinal hemorrhage and adverse outcome. Accordingly, pl asma fibrinolytic tests may constitute an appropriate prognostic marker in upper gastrointestinal bleeding.