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Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding
Minoru Tomizawa1, Fuminobu Shinozaki1, Rumiko Hasegawa1
1Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan.
Insights
Early upper gastrointestinal endoscopy aids in identifying bleeding risks. Key predictors include low hemoglobin and elevated C-reactive protein levels, indicating potential gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Internal Medicine
- Diagnostic Medicine
Background:
- Upper gastrointestinal (GI) bleeding is a significant clinical concern.
- Early detection and intervention are crucial for reducing mortality associated with GI bleeding.
Purpose of the Study:
- To evaluate the predictive value of hemoglobin (Hb) and C-reactive protein (CRP) levels for upper GI bleeding.
- To determine if changes in Hb and CRP can predict the occurrence of upper GI bleeding.
Main Methods:
- Patients with upper GI bleeding were classified using the Forrest classification.
- Hemoglobin (Hb) and C-reactive protein (CRP) levels were measured around the time of endoscopy and 3 months prior.
- The rate of change in Hb and CRP was calculated to assess temporal trends.
Main Results:
- Hemoglobin levels below 11.7 g/dL showed high sensitivity (94.1%) and specificity (77.1%) for predicting upper GI bleeding.
- A reduction rate in Hb greater than 21.3% and an increase in CRP greater than 100% were significant predictors.
- The rate of change in CRP demonstrated high predictive accuracy (AUC 0.901).
Conclusions:
- Hemoglobin levels < 11.7 g/dL are indicative of upper GI bleeding risk.
- A significant decrease in Hb (>21.3%) or a substantial increase in CRP (>100%) within 3 months prior to endoscopy are strong predictors.
- These biochemical markers can aid in the early identification of patients at risk for upper GI bleeding.
Aim:
To investigate the early upper gastrointestinal endoscopy (endoscopy) significantly reduces mortality resulting from upper gastrointestinal (GI) bleeding.
Methods:
Upper GI bleeding was defined as 1a, 1b, 2a, and 2b according to the Forrest classification. The hemoglobin (Hb), and C-reactive protein (CRP) were examined at around the day of endoscopy and 3 mo prior to endoscopy. The rate of change was calculated as follows: (the result of blood examination on the day of endoscopy - the results of blood examination 3 mo prior to endoscopy)/(results of blood examination 3 mo prior to endoscopy). Receiver operating characteristic curves were created to determine threshold values.
Results:
Seventy-nine men and 77 women were enrolled. There were 17 patients with upper GI bleeding: 12 with a gastric ulcer, 3 with a duodenal ulcer, 1 with an acute gastric mucosal lesion, and 1 with gastric cancer. The area under the curve (AUC), threshold, sensitivity, and specificity of Hb around the day of endoscopy were 0.902, 11.7 g/dL, 94.1%, and 77.1%, respectively, while those of CRP were 0.722, 0.5 mg/dL, 70.5%, and 73%, respectively. The AUC, threshold, sensitivity, and specificity of the rate of change of Hb were 0.851, -21.3%, 76.4%, and 82.6%, respectively, while those of CRP were 0.901, 100%, 100%, and 82.5%, respectively.
Conclusion:
Predictors for upper GI bleeding were Hb < 11.7 g/dL, reduction rate in the Hb > 21.3% and an increase in the CRP > 100%, 3 mo before endoscopy.
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