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

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
JournalUnited European Gastroenterology Journal
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Christianity
Hemorrhage
Blood Transfusion
Hemoglobins
Mortality
Tokyo
Triage
Varicose Veins
Peptic Ulcer
Endoscopy
Emergencies
Cohort Studies
Odds Ratio
Prospective Studies
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

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

In: United European Gastroenterology Journal, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "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.",
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author = "Masayasu Horibe and Yuki Ogura and Juntaro Matsuzaki and Tetsuji Kaneko and Takuya Yokota and Osamu Okawa and Yukihiro Nakatani and Eisuke Iwasaki and Toshihiro Nishizawa and Naoki Hosoe and Tatsuhiro Masaoka and Naohisa Yahagi and Shin Namiki and Takanori Kanai",
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T1 - Absence of high-risk stigmata predicts good prognosis even in severely anemic patients with suspected acute upper gastrointestinal bleeding

AU - Horibe, Masayasu

AU - Ogura, Yuki

AU - Matsuzaki, Juntaro

AU - Kaneko, Tetsuji

AU - Yokota, Takuya

AU - Okawa, Osamu

AU - Nakatani, Yukihiro

AU - Iwasaki, Eisuke

AU - Nishizawa, Toshihiro

AU - Hosoe, Naoki

AU - Masaoka, Tatsuhiro

AU - Yahagi, Naohisa

AU - Namiki, Shin

AU - Kanai, Takanori

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

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KW - emergent endoscopy

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KW - outpatient management

KW - triage

KW - Upper gastrointestinal bleeding

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