Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center.
2013
Background & Aims. For upper gastrointestinal bleeding (UGIB), guidelines recommend pharmacological treatment before endoscopy. �erefore, it is important to establish an early diagnosis of the variceal or non-variceal source of bleeding. �is 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. �is 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 nonvariceal 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
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