Predictors of Short and Long-term Rebleeding in Patients With Overt Gastrointestinal Bleeding: A Prospective Study.

BACKGROUND

We aimed to identify predictors of rebleeding in patients with overt gastrointestinal bleeding (GIB) and to develop a rebleeding index.

METHODS

This was a prospective study of patients admitted with GIB from 2013 to 2023 at a tertiary care center. Rebleeding was defined as the recurrence of visible bleeding after initial stabilization, endoscopic evaluation, and/or hemostatic therapy, accompanied by a change in vital signs or a hemoglobin (Hgb) decrease of ≥2 g/dL. Independent predictors were determined after adjusting for confounders.

RESULTS

Seven hundred ninety-seven patients with GIB were recruited between 2013 and 2023 and were followed up until death or January 2023. In-hospital, 1-month, 1-year, and end of follow-up rebleeding rates were: 5.3%, 8.9%, 16.2%, and 21.8%, respectively. Sources of rebleeding were different from the original sources in 36% of patients. Predictors of 1-month rebleeding included need for ≥3 packed red blood cell (PRBC) units (HR=1.86; p =0.041), endoscopic stigmata of recent hemorrhage (SRH) (HR=1.99; p =0.007), and Hgb level (HR=0.82; p =0.018; lower Hgb predicts higher rebleeding risk). A rebleeding index based on SRH, Hgb level, and ≥3 PRBC units showed modest performance (AUC=0.68), with higher scores indicating increased rebleeding risk. At the end of follow-up, SRH remained a predictor (HR=1.61; p =0.003), whereas antiplatelets on admission or discharge appeared protective against rebleeding (HR=0.66; p =0.021; HR=0.63; p =0.026).

CONCLUSION

Predictors of rebleeding after GIB were SRH, PRBC transfusion, and lowest Hgb. The novel index based on these predictors performed favorably compared with the GBS, Rockall systems for UGUB and ABC scores. These data will help guide management and risk stratification of patients with GIB.