Clinical predictors of outcome in acute upper gastrointestinal bleeding

Objective: Endoscopy has traditionally been used to risk-stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful recovery. Design: Prospective, descriptive cross-sectional study. Setting. Groote Schuur Hospital, Cape Town. Subjects: Two hundred consecutive patients aged over 12 years, presenting with haematemesis and/or melaena. Outcome measures: Good outcome, i.e. no blood transfusion, endotherapy or surgery, and alive at 1 month following presentation. Results: Eighty patients (40%) had a good outcome. Haemoglobin > 10 g/dl (odds ratio (OR) 25.5, 95% confidence interval (CI): 8.9 - 74.8; p 10 g/dl, no melaena and no syncope; 3 (10%) had a poor outcome (required endotherapy). Conclusion: The prediction rule accurately excluded poor outcome, a priority in the clinical context, but did not predict good outcome. Clinical implications are a 15% reduction in unnecessary urgent endoscopies, with less than 5% of patients with poor outcome not undergoing urgent endoscopy. These findings may have particular clinical relevance in under-resourced health care environments