Values of Blood Coagulation Parameters in Distinguishing Esophagogastric Variceal Bleeding from Peptic Ulcer Bleeding.

BACKGROUND: Esophagogastric variceal bleeding (EGVB), manifested with similar symptoms of hematemesis and/ or melaena, is often difficult to differentiate from peptic ulcer bleeding (PUB). It remains unclear whether blood coagulation parameters can be used to distinguish between EGVB and PUB.

METHODS: A total of 37 EGVB patients (EGVB group) and 89 cases with PUB (PUB group), were enrolled for final analysis retrospectively. The levels of coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), Fibrinogen, and D-dimer, were tested in the emergency department and compared between the two groups. Student's t-test was adopted for comparing the mean. Model discrimination was evaluated by using the area under the receiver operating characteristic curve (AUC).

RESULTS: Compared with PUB group, PT, APTT, and D-dimer were significantly increased, while fibrinogen was significantly decreased in EGVB group (all p < 0.01); moreover, binary logistic regression analysis adjusted for covariate showed that PT, APTT, fibrinogen, and D-dimer remained independent risk factors for predicting EGVB; next, the AUC in distinguishing EGVB from PUB were 0.843, 0.725, 0.766, and 0.821 for PT, APTT, fibrinogen, and D-dimer, respectively; finally, the cutoff values (specificity, sensitivity, and Youden index) in distinguishing EGVB from PUB were 12.9 s (80.9%, 78.4%, 0.593) for PT, 25.1 s (68.5%, 78.4%, 0.469) for APTT, 1.99 g/L (67.4%, 75.7%, 0.431) for fibrinogen, and 0.31 mg/L (75.3%, 78.4%, 0.537) for D-dimer, respectively.

CONCLUSIONS: PT, APTT, fibrinogen, and D-dimer, useful and potential biomarkers in distinguishing EGVB from PUB, can demonstrate accurate and reliable diagnostic values.