Related Experiment Video
Updated: Jul 15, 2026
Establishment and Evaluation of a Risk Prediction Model for Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia
Published on: February 16, 2024
Clinical predictors of outcome in acute upper gastrointestinal bleeding
S Z Kalula1, G H Swingler, J A Louw
1Division of Geriatrics, Department of Medicine, University of Cape Town.
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 < 0.001), absence of melaena (OR 4.8, 95% CI: 1.79-12.94, p = 0.002) and absence of syncope (OR 4.0, 95% CI: 1.67-9.48; p = 0.002) were independent predictors of good outcome. The three variables combined as a positive test had the best association with good outcome when compared with a single variable or a combination of two variables. The three-variable model had sensitivity for good outcome of 34%, specificity of 98%, and likelihood ratio for a positive test of 13.5 and for a negative test of 0.68. Thirty patients (15%) had the combination for the prediction rule, i.e. haemoglobin > 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.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:30Peptic Ulcer Disease I: Introduction
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:27Peptic Ulcer
01:25Peptic Ulcer Disease III: Clinical Manifestations and Complications