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Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center.
J Gastrointestin Liver Dis. 2013 Dec; 22(4):379-84.JG

Abstract

BACKGROUND

&

AIMS.

For upper gastrointestinal bleeding (UGIB), guidelines recommend pharmacological treatment before endoscopy. Therefore, it is important to establish an early diagnosis of the variceal or non-variceal source of bleeding. This study aims to analyze the clinical and laboratory parameters which are predictors of the UGIB etiology, and to develop a score for predicting variceal or non-variceal bleeding.

METHODS.

This study comprised patients presenting to the emergency department of a tertiary care center with UGIB, throughout a 1-year period. Clinical, ultrasound data and laboratory parameters were noted.

RESULTS.

Of the 517 patients with UGIB, 29.8% had variceal and 70.2% non-variceal bleeding. Six factors were associated with variceal hemorrhage: cirrhosis (OR=10.74, 95% CI: 3.50-32.94, p<0.001), history of variceal hemorrhage (OR=13.11, 95%CI: 3.09-55.57, p<0.001), ascites (OR=4.41, 95% CI: 1.74-11.16, p=0.002), thrombocytopenia (OR=2.77, 95% CI: 1.18-6.50, p=0.01), elevated INR (OR=4.77, 95% CI:1.47-15.42, p=0.009) and elevated bilirubin levels (OR=2.43, 95% CI:1.01-5.84, p=0.04). Two factors were associated with non-variceal bleeding: the use of NSAIDs (OR=0.32, 95%CI: 0.13-0.83, p=0.01) and of anticoagulants (OR=0.04, 95%CI: 0.00-0.89, p=0.04). A prediction score for UGIB etiology was designed based on this model. We calculated a cutoff value of 0.968, higher values being predictive of variceal bleeding. Positive predictive value (PPV) and negative predictive value (NPV) were: 82.7% and 97%, respectively. The score was validated prospectively in another group of 162 patients: PPV and NPV were 72.7% and 95.3%, respectively.

CONCLUSIONS.

Several factors were identified as predictors for the etiology of UGIB. Due to its high PPV and NPV, our UGIB etiology score might be useful in predicting variceal bleeding and could assist in the selection of pharmacological therapy before endoscopy.

Authors+Show Affiliations

Regional Institute of Gastroenterology and Hepatology Prof. Dr. Octavian Fodor,Cluj-Napoca, Romania; Email:stefanvesa@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study
Validation Study

Language

eng

PubMed ID

24369318

Citation

Matei, Daniela, et al. "Predictors of Variceal or Nonvariceal Source of Upper Gastrointestinal Bleeding. an Etiology Predictive Score Established and Validated in a Tertiary Referral Center." Journal of Gastrointestinal and Liver Diseases : JGLD, vol. 22, no. 4, 2013, pp. 379-84.
Matei D, Groza I, Furnea B, et al. Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. J Gastrointestin Liver Dis. 2013;22(4):379-84.
Matei, D., Groza, I., Furnea, B., Puie, L., Levi, C., Chiru, A., Cruciat, C., Mester, G., Vesa, S. C., & Tantau, M. (2013). Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. Journal of Gastrointestinal and Liver Diseases : JGLD, 22(4), 379-84.
Matei D, et al. Predictors of Variceal or Nonvariceal Source of Upper Gastrointestinal Bleeding. an Etiology Predictive Score Established and Validated in a Tertiary Referral Center. J Gastrointestin Liver Dis. 2013;22(4):379-84. PubMed PMID: 24369318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. AU - Matei,Daniela, AU - Groza,Ioana, AU - Furnea,Bogdan, AU - Puie,Lidia, AU - Levi,Cristina, AU - Chiru,Andrei, AU - Cruciat,Carmen, AU - Mester,Gabriela, AU - Vesa,Stefan Cristian, AU - Tantau,Marcel, PY - 2013/12/27/entrez PY - 2013/12/27/pubmed PY - 2014/7/9/medline SP - 379 EP - 84 JF - Journal of gastrointestinal and liver diseases : JGLD JO - J Gastrointestin Liver Dis VL - 22 IS - 4 N2 - BACKGROUND & AIMS. For upper gastrointestinal bleeding (UGIB), guidelines recommend pharmacological treatment before endoscopy. Therefore, it is important to establish an early diagnosis of the variceal or non-variceal source of bleeding. This study aims to analyze the clinical and laboratory parameters which are predictors of the UGIB etiology, and to develop a score for predicting variceal or non-variceal bleeding. METHODS. This study comprised patients presenting to the emergency department of a tertiary care center with UGIB, throughout a 1-year period. Clinical, ultrasound data and laboratory parameters were noted. RESULTS. Of the 517 patients with UGIB, 29.8% had variceal and 70.2% non-variceal bleeding. Six factors were associated with variceal hemorrhage: cirrhosis (OR=10.74, 95% CI: 3.50-32.94, p<0.001), history of variceal hemorrhage (OR=13.11, 95%CI: 3.09-55.57, p<0.001), ascites (OR=4.41, 95% CI: 1.74-11.16, p=0.002), thrombocytopenia (OR=2.77, 95% CI: 1.18-6.50, p=0.01), elevated INR (OR=4.77, 95% CI:1.47-15.42, p=0.009) and elevated bilirubin levels (OR=2.43, 95% CI:1.01-5.84, p=0.04). Two factors were associated with non-variceal bleeding: the use of NSAIDs (OR=0.32, 95%CI: 0.13-0.83, p=0.01) and of anticoagulants (OR=0.04, 95%CI: 0.00-0.89, p=0.04). A prediction score for UGIB etiology was designed based on this model. We calculated a cutoff value of 0.968, higher values being predictive of variceal bleeding. Positive predictive value (PPV) and negative predictive value (NPV) were: 82.7% and 97%, respectively. The score was validated prospectively in another group of 162 patients: PPV and NPV were 72.7% and 95.3%, respectively. CONCLUSIONS. Several factors were identified as predictors for the etiology of UGIB. Due to its high PPV and NPV, our UGIB etiology score might be useful in predicting variceal bleeding and could assist in the selection of pharmacological therapy before endoscopy. SN - 1842-1121 UR - https://www.unboundmedicine.com/medline/citation/24369318/Predictors_of_variceal_or_nonvariceal_source_of_upper_gastrointestinal_bleeding__An_etiology_predictive_score_established_and_validated_in_a_tertiary_referral_center_ L2 - http://www.jgld.ro/2013/4/4.html DB - PRIME DP - Unbound Medicine ER -