Clinical and endoscopic signs for the prediction of recurrent bleeding from gastroduodenal ulcers.

OBJECTIVE

To evaluate the prognostic importance of various clinical and endoscopic signs in patients who rebled after endoscopic treatment of gastroduodenal ulcers, and to create a predictive index using regression analysis.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Lithuania.

SUBJECTS: 659 patients whose bleeding peptic ulcers were treated endoscopically (out of a total of 949 with bleeding peptic ulcers seen from 1982-1991).

INTERVENTIONS: Endoscopic haemostasis (laser or electrocoagulation, or injection sclerotherapy).

MAIN OUTCOME MEASURES: Mortality, incidence of rebleeding, and identification of prognostic factors.

RESULTS

Of the 75 patients who rebled 25 died (33%), compared with 23 of the 584 who did not (4%). 57 patients (76%) rebled within two days of endoscopy, and 70 (94%) within a week. 59 variables from the group of 75 who rebled and from a control group of 100 who did not were analysed by logistic regression to construct a predictive index. The following 12 variables were found to be significantly associated with recurrent haemorrhage: frequency and type of bleeding; length of time between episodes of bleeding at home; shock index on admission; speed of reduction in haemoglobin concentration; size and type of ulcer, and whether it was complicated; endoscopic appearance of ulcer; number of ulcers, sex of the patient, and presence of associated diseases (liver disease, coagulopathy, hypertension, or heart disease). The accuracy of the index varied from 78.4% in the prediction of a high risk of rebleeding to 100% in the prediction of a low risk.

CONCLUSION

By using the predictive index we have been able to improve our management of patients with bleeding peptic ulcers.