1. Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: Implications for early discharge?
- Author
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Angelo Dezi, Salvatore Tronci, Alessandro Casadei, F. Giangregorio, Tommaso Ceglia, Nicola Pandolfo, Giuseppe Chianese, Giovanni Aragona, I. Stroppa, Riccardo Marmo, R. Macchiarelli, Giorgio Chiozzini, Paolo Giorgio, A. Buzzi, Paola Romagnoli, Francesca Rogai, Anna Tanzilli, Angelo Pera, Mario Salvagnini, L. Pietrini, Renato Fasoli, S. Boschetto, Fabio Fornari, Giorgio Minoli, Livio Cipolletta, W. Piubello, Giampiero Bagnalasta, Sergio Segato, Daniela Di Muzio, Lisa Girardi, G. Frosini, U. Germani, Fabrizio Bonfante, Claudio Cortini, G. Trallori, Sirio Bagnoli, Renzo Cestari, Maria Antonia Bianco, Roberto Di Mitri, Elena Sainz Torre, Salvatore De Stefano, G. Imperiali, G. Gatto, Paolo Michetti, V. Peri, M. Pagliarulo, Amuso M, Rodolfo Rocca, Luciano Allegretta, Gianluca Rotondano, Sergio Brunati, O. Triossi, Andrea Nucci, Tino Casetti, Ivano Lorenzini, Domenico Della Casa, Marco Martorano, F. Barberani, I. Sorrentini, Massimo Proietti, Alfredo Pastorelli, Alessandro Gigliozzi, Marino Di Cicco, Enzo Grossi, Maurizio Koch, Claudio Leoci, Maria Tebaldi, and Barbara Ferri
- Subjects
Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Multivariate analysis ,Adverse outcomes ,Stomach Diseases ,Esophageal Diseases ,Risk Assessment ,Outcome (game theory) ,Recurrence ,Internal medicine ,medicine ,Humans ,Blood Transfusion ,Endoscopy, Digestive System ,Prospective Studies ,Early discharge ,Aged ,Aged, 80 and over ,Aspirin ,Hepatology ,business.industry ,Hemostasis, Endoscopic ,Age Factors ,Gastroenterology ,Middle Aged ,Prognosis ,medicine.disease ,Patient Discharge ,Surgery ,Treatment Outcome ,ROC Curve ,Multivariate Analysis ,Female ,Upper gastrointestinal bleeding ,Gastrointestinal Hemorrhage ,Risk assessment ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding.Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death).Secondary analysis of two prospective multicenter studies. Multivariate analyses for each investigated outcome were performed; a single model was developed including all factors that were statistically significant in each sub-model. A final score was developed to predict favourable outcomes. Prognostic accuracy was tested with ROC curve analysis.Out of 2398 patients, 211 (8.8%) developed one or more adverse outcomes: 87 (3.63%) had rebleeding, 46 (1.92%) needed surgery and 107 (4.46%) died. Predictors of favourable prognosis were: ASA score 1 or 2, absence of neoplasia, outpatient bleeding, use of low-dose aspirin, no need for transfusions, clean-based ulcer, age70 years, no haemodynamic instability successful endoscopic diagnosis/therapy, no Dieulafoy's lesion at endoscopy, no hematemesis on presentation and no need for endoscopic treatment. Overall prognostic accuracy of the model was 83%. The final score accurately identified 20-30% of patients that eventually do not develop any negative outcome.The "good luck score" may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding.
- Published
- 2014
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