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Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: Implications for early discharge?

2013; Elsevier BV; Volume: 46; Issue: 3 Linguagem: Inglês

10.1016/j.dld.2013.10.017

1878-3562

G. Rotondano, Livio Cipolletta, M. Koch, Maria Antonia Bianco, Enzo Grossi, Riccardo Marmo, A. Pera, Rodolfo Rocca, Angelo Dezi, R. Fasoli, Sergio Brunati, I. Lorenzini, Ugo Germani, Paolo Giorgio, G Imperiali, Giorgio Minoli, F. Barberani, S. Boschetto, Marco Martorano, G. Gatto, M. Amuso, Alfredo Pastorelli, Elena S. Torre, O. Triossi, A. Buzzi, Renzo Cestari, Domenico Della Casa, M. Proietti, Anna Tanzilli, Giovanni Aragona, F. Giangregorio, Luciano Allegretta, Salvatore Tronci, Paolo Michetti, Paola Romagnoli, Andrea Nucci, Francesca Rogai, W. Piubello, Maria Tebaldi, F. Bonfante, Alessandro Casadei, C. Cortini, G Chiozzini, Lisa Girardi, Claudio Leoci, Giampiero Bagnalasta, Sergio Segato, Giuseppe Chianese, M. Salvagnini, N Pandolfo, T. Casetti, Italo Stroppa, Alessandro Gigliozzi, V. Peri, Marino Di Cicco, B. Ferri, Fabio Fornari, M. Pagliarulo, Roberto Di Mitri, Giacomo Trallori, S Bagnoli, G. Frosini, Raffaele Macchiarelli, I. Sorrentini, L. Pietrini, Salvatore De Stefano, T. Ceglia, Daniela Di Muzio,

Gastrointestinal Tumor Research and Treatment

Background There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding. Aims Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death). Methods 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. Results 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, age <70 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. Conclusions The “good luck score” may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding.