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
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.