Absence of high-risk stigmata predicts good prognosis even in severely anemic patients with suspected acute upper gastrointestinal bleeding

作者：Horibe Masayasu; Ogura Yuki; Matsuzaki Juntaro; Kaneko Tetsuji; Yokota Takuya; Okawa Osamu; Nakatani Yukihiro; Iwasaki Eisuke; Nishizawa Toshihiro; Hosoe Naoki; Masaoka Tatsuhiro; Yahagi Naohisa; Namiki Shin; Kanai Takanori^*

来源：United European Gastroenterology Journal, 2018, 6(5): 684-690.

DOI：10.1177/2050640618764161

• Upper gastrointestinal bleeding
• blood transfusion
• high-risk stigmata
• outpatient management
• triage
• emergent endoscopy

Background: The need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure for assessing the risk levels in patients with upper gastrointestinal bleeding (UGIB). However, not all patients with a low hemoglobin level have a poor prognosis.
Objective: We assessed the clinical predictive factors associated with poor short-term prognosis in patients with a low hemoglobin level.
Methods: In this prospective cohort study, all consecutive patients with suspected acute UGIB at Tokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015. Then, we extracted those who needed a blood transfusion (hemoglobin < 70 g/L) and explored the variables associated with all-cause mortality within 28 days after presentation.
Results: Among 1307 patients, 311 needed a blood transfusion and 13 (4.2%) died from all causes. The presence of high-risk stigmata requiring endoscopic treatment (peptic ulcers; Forrest scores Ia, Ib and IIa; varices with current bleeding or signs of recent bleeding; and spurting or gushing bleeding or visible vessel in other diseases), diagnosed by emergency endoscopy, was a unique factor affecting mortality (odds ratio: 8.47, 95% confidence interval: 1.45-160, P = 0.01). Patients without high-risk stigmata neither died from UGIB nor had rebleeding, irrespective of the hemoglobin levels.
Conclusions: Patients without high-risk stigmata showed a good prognosis even if they needed a blood transfusion. This result could facilitate triage of patients with suspected acute UGIB who only need a blood transfusion.

• 出版日期2018-6