Outcome of upper gastrointestinal hemorrhage according to the bleed risk classification : a two-year prospective survey

Abstract EN

Objective: Upper gastrointestinal bleeding (UGIB) is a common and serious medical emergency.

The aim of this study was to predict UGIB patients' outcome according to a risk scoring system, independent of endoscopic findings, introduced by Kollef et al (BLEED: ongoing bleeding, elevated prothrombin time, erratic mental status, and unstable co-morbid disease).

Design: Prospective study.

Setting: Sina university hospital.

Method: We studied all patients who presented with UGIB during 2000 to 2002.

Patients meeting the BLEED criteria at their initial assessment were classified as highrisk (71) and all others were categorized as low-risk (50).

In-hospital complications were defined as recurrent UGIB, surgery to control the source of hemorrhage and hospital mortality.

Results: There were 101 patients, aged 55.7±20.8 years.

Re-bleeding, surgery and death occurred in 21 (20.8%), 28 (27.7%) and 14 (13.9%) of the patients, respectively.

Therapeutic and diagnostic upper gastrointestinal endoscopy were performed in 7 (7%) and 83 (82.2%) of patients, respectively.

Seventy percent were categorized as high-risk.

There was significant difference in development of in-hospital complications, and death when considered individually, between the high and low-risk patients, but not in the rate of re-bleeding, length of hospital stay and transfused units of packed red blood cells.

High-risk patients needed surgery more often than the lowrisk cases but the difference was borderline significant (p=0.051).

Low systolic blood pressure and elevated prothrombin time were independent predictors of in-hospital complications among BLEED criteria.

Conclusion: BLEED classification was capable of predicting in-hospital complications, especially mortality.

It is, therefore, a helpful triage tool in centers where urgent endoscopy is hardly available.