Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding

Background: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency. In the place where urgent esophagogastroduodenoscopy (EGD) is unavailable, empirical pharmacological therapy with vasoactive drugs for variceal bleeding or proton pump inhibitors for nonvariceal bleeding is recommended. However, the values of using clinical data for predicting the types of UGIB are unclear. The aim of this study is to determine the values and efficacy of clinical and basic laboratory parameters in predicting the types of UGIB. Methods: All patients with UGIB underwent EGD within 72 hours. Clinical and basic laboratory parameters were collected prospectively. The associations between each factors and the final diagnosis of UGIB were assessed using univariate and multivariate analysis. Model of a predicting score to predict the type of UGIB was developed. Results: Two hundreds and sixty-one patients with UGIB were enrolled into the study. Of these, 47 (18%) were variceal and 214 (82%) were nonvariceal bleeding. Univariate analysis identified 27 distinct parameters associated with the types of UGIB. A stepwise logistic regression analysis identified 3 variables as independent factors to predict types of UGIB; previous diagnosis of cirrhosis or presence of signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4), red or bloody vomitus (OR 4.6, 95% CI 1.7-11.9), and red or bloody NG aspirate (OR 3.3, 95% CI 1.3-8.3). Variceal bleeding predicting scoring model was developed as: Z = (3.1 × previously diagnosed cirrhosis or presence of signs of chronic liver disease) + (1.4 × red or bloody vomitus) + (1.2 × red or bloody NG aspirate) 4.1, while 1 and 0 are used for the presence and absence of each factor, respectively. The probability of variceal bleeding is calculated from 1/(1+e -Z) or by plotting to the exponential graph. The probabilities of variceal bleeding are >90%, >60%, <10% and <5% for the presence of 3, 2, 1 and 0 factors, respectively. Conclusion: Three clinical parameters and variceal bleeding predicting score are useful to predict the types of UGIB and may aid clinical judgment for the initial management of UGIB before endoscopy.