Tomizawa et al identified factors associated with upper gastrointestinal bleeding in a patient undergoing endoscopy. The authors are from National Hospital Organization Shimoshizu Hospital in Japan.
Patient selection: upper GI endoscopy
Requirement: laboratory data available 3 to 6 months prior to endoscopy and also around the time of the procedure
Upper GI bleeding was defined as Forrest Ia, 1b, 2a and 2b.
Predictors of upper GI bleeding:
(1) hemoglobin < 11.7 g/dL
(2) increase in serum C-reactive protein over prior sample by > 100% (doubling of prior value or more)
(3) decrease in hemoglobin from prior sample by > 21.3%
change in hemoglobin =
= ((hemoglobin 3 months ago) - (current hemoglobin)) / (hemoglobin 3 months ago)
current CRP as multiple of previous =
= (current CRP) / (previous CRP)
|
Parameter
|
Finding
|
Points
|
|
current hemoglobin
|
>= 11.7 g/dL
|
0
|
|
|
< 11.7 g/dL
|
1
|
|
CRP ratio to previous
|
<= 2
|
0
|
|
|
> 2
|
1
|
|
change in hemoglobin
|
<= 21.3%
|
0
|
|
|
> 21.3%
|
1
|
total number of predictors =
= SUM(points for all 3 factors)
Interpretation:
• minimum number: 0
• maximum number: 3
• The risk of upper GI bleeding increases with the number of predictors present.
Performance:
• The area under the ROC curve for current hemoglobin was 0.90.
• The area under the ROC curve for change in serum CRP was 0.90.
• The area under the ROC curve for change in hemoglobin was 0.85.
