Prognostic factors for ongoing or recurrent lower GI bleeding are not well defined.
In this study, doctors from the United States identified risk factors for severe lower GI bleeding and for significant adverse outcomes.
The team identified 448 patients who sought attention for GI bleeding during a 3-year period.
Of the 448 patients, 21% had lower GI bleeding.
The team recorded the clinical predictors available in the first hour of evaluation.
|20% of patients experienced a significant adverse outcome.|
|Clinical Gastroenterology and Hepatology|
The primary outcome was severe lower GI bleeding. This was defined as gross blood per rectum after leaving the emergency department associated with either abnormal vital signs or more than a 2-unit blood transfusion during the hospitalization.
The team also recorded the occurrence of significant adverse outcomes, including death.
The team found that 37 patients had severe lower GI bleeding.
They determined that risk factors included initial hematocrit ≤35% (OR 6.3), abnormal vital signs 1 hour after initial evaluation (OR 4.3), and gross blood on initial rectal examination (OR 3.9).
The team found that 20% of patients experienced a significant adverse outcome. There were 3 deaths.
The doctors identified severe lower GI bleeding (OR 5.3) as the main predictor of an adverse outcome.
Dr Fernando Velayos and colleagues concluded, "Risk factors are available in the first hour of evaluation in the emergency department to identify patients at risk for severe lower gastrointestinal bleeding".
"Severe lower gastrointestinal bleeding is a significant risk factor for global adverse outcomes".