BackgroundThe need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure forassessing the risk levels in patients with upper gastrointestinal bleeding (UGIB).However, not all patients with a low hemoglobin level have a poor prognosis.ObjectiveWe assessed the clinical predictive factors associated with poor short-term prognosisin patients with a low hemoglobin level.MethodsIn this prospective cohort study, all consecutive patients with suspected acute UGIB atTokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015. Then, weextracted those who needed a blood transfusion (hemoglobin < 70 g/L) and explored thevariables associated with all-cause mortality within 28 days after presentation.ResultsAmong 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 recentbleeding; 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 withouthigh-risk stigmata neither died from UGIB nor had rebleeding, irrespective of thehemoglobin levels.ConclusionsPatients without high-risk stigmata showed a good prognosis even if they needed a bloodtransfusion. This result could facilitate triage of patients with suspected acute UGIBwho only need a blood transfusion.
United European Gastroenterology Journal – SAGE
Published: Jun 1, 2018