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. 2012 Apr;26(4):187-92.
doi: 10.1155/2012/349324.

Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding

Ahmad Alharbi  1 , Majid Almadi, Alan Barkun, Myriam Martel; REASON Investigators
Collaborators, Affiliations

Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding

Ahmad Alharbi et al. Can J Gastroenterol. 2012 Apr.

Abstract
in English, French

Background: Patients with upper gastrointestinal bleeding (UGIB) require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source.

Objective: To identify, by investigating a large national registry, variables that would be predictive of a variceal origin of UGIB using clinical parameters before endoscopic evaluation.

Methods: A retrospective study was conducted in 21 Canadian hospitals during the period from January 2004 until the end of May 2005. Consecutive charts for hospitalized patients with a primary or secondary discharge diagnosis of UGIB were reviewed. Data regarding demographics, including historical, physical examination, initial laboratory investigations, endoscopic and pharmacological therapies administered, as well as clinical outcomes, were collected. Multivariable logistic regression modelling was performed to identify clinical predictors of a variceal source of bleeding.

Results: The patient population included 2020 patients (mean [± SD] age 66.3±16.4 years; 38.4% female). Overall, 215 (10.6%) were found to be bleeding from upper gastrointestinal varices. Among 26 patient characteristics, variables predicting a variceal source of bleeding included history of liver disease (OR 6.36 [95% CI 3.59 to 11.3]), excessive alcohol use (OR 2.28 [95% CI 1.37 to 3.77]), hematemesis (OR 2.65 [95% CI 1.61 to 4.36]), hematochezia (OR 3.02 [95% CI 1.46 to 6.22]) and stigmata of chronic liver disease (OR 2.49 [95% CI 1.46 to 4.25]). Patients treated with antithrombotic therapy were more likely to experience other causes of hemorrhage (OR 0.44 [95% CI 0.35 to 0.78]).

Conclusion: Presenting historical and physical examination data, and initial laboratory tests carry significant predictive ability in discriminating variceal versus nonvariceal sources of bleeding.

HISTORIQUE :: Les patients présentant des saignements œsogas-troduodénaux (SOGD) ont besoin d’une approche précoce et personnalisée orientée par la connaissance de la lésion hémorragique, notamment son origine variqueuse ou non variqueuse.

OBJECTIF :: En examinant un grand registre national, déterminer les variables prédictives de SOGD d’origine variqueuse au moyen de paramètres cliniques relevés avant l’évaluation endoscopique.

MÉTHODOLOGIE :: Les chercheurs ont procédé à une analyse prospective dans 21 hôpitaux canadiens entre janvier 2004 et la fin de mai 2005. Ils ont analysé les dossiers consécutifs de patients hospitalisés dont le diagnostic primaire ou secondaire au congé en était un de SOGD. Ils ont colligé des données au sujet des facteurs démographiques, y compris les antécédents, l’examen physique, les premiers examens de laboratoire, les traitements endoscopiques et pharmacologiques administrés et les issues cliniques. Ils ont effectué une modélisation de la régression logistique multivariable pour déterminer les variables prédictives cliniques de saignements d’origine variqueuse.

RÉSULTATS :: La population à l’étude se composait de 2 020 patients (âge moyen [±ÉT] de 66,3±16,4 ans; 38,4 % de femmes). Dans l’ensemble, 215 (10,6 %) avaient des saignements causés par des varices œsogastroduodénales. Parmi 26 caractéristiques des patients, les variables prédictives de saignements d’origine variqueuse incluaient des antécédents de maladie hépatique (RRR 6,36 [95 % IC 3,59 à 11,3]), de consommation excessive d’alcool (RRR 2,28 [95 % IC 1,37 à 3,77]), d’hématémèse (RRR 2,65 [95 % IC 1,61 à 4,36]), d’hématochézie (RRR 3,02 [95 % IC1,46 à 6,22]) et de stigmates de maladie hépatique chronique (RRR 2,49 [95 % IC 1,46 à 4,25]). Les patients traités aux antithrombotiques étaient plus susceptibles d’avoir des saignements attribuables à d’autres causes (RRR 0,44 [95 % IC 0,35 à 0,78]).

CONCLUSION :: Les antécédents, les données de l’examen physique et les premiers tests de laboratoire s’associent à une importante capacité prédictive de distinguer des saignements d’origine variqueuse de ceux d’origine non variqueuse.

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