Velayos et al identified factors predictive of severe disease in a patient presenting with acute lower gastrointestinal (GI) bleeding. The authors are from the University of California San Francisco and Arizona State University in Tempe, Arizona.


Risk factors for severe lower GI bleeding evident soon after admission:

(1) initial hematocrit <= 35%

(2) abnormal vital signs after 1 hour (systolic blood pressure < 100 mm Hg and/or heart rate > 100 beats per minute)

(3) gross blood on the initial rectal examination



• The odds ratio for the risk factors range from 3.9 to 6.3.


Adverse outcomes associated with lower GI bleeding:

(1) death

(2) acute myocardial infarction

(3) congestive heart failure

(4) cardiac arrhythmia

(5) stroke

(6) respiratory failure

(7) nosocomial infection requiring therapy with antibiotics

(8) onset of delirium and/or encephalopathy

(9) onset of any condition that results in a prolonged hospital stay


The only independent risk factor for an adverse outcome was severe lower GI bleeding.


Additional risk factors for adverse outcomes during the hospitalization:

(1) initial hematocrit <= 35%

(2) age of the patient > 65 years

(3) initial diastolic blood pressure < 60 mm Hg

(4) serum creatinine >= 1.5 g/dL


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