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Defining and Evaluating the Impact of Bleeding Severity on Time to Endoscopy and Mortality Risk: A Prospective
Clelia Marmo1, Cristina Bucci2, Marco Soncini3
1CEMAD Centro Malattie Dell'Apparato Digerente, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 00168 Rome, Italy.
Journal of Clinical Medicine
|March 17, 2025
Summary
A new model defines upper gastrointestinal bleeding severity (BleSev) using five key factors. High BleSev increases death risk, but early endoscopy benefits only the highest-risk patients.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Medical Research
Background:
- Upper gastrointestinal bleeding severity (BleSev) assessment often relies on interdependent factors.
- A unified definition for BleSev is needed to accurately predict outcomes.
Purpose of the Study:
- To define upper gastrointestinal bleeding severity (BleSev).
- To assess BleSev's impact on mortality and optimal timing for endoscopy.
Main Methods:
- Analysis of 12 demographic, hemodynamic, biochemical, and clinical factors in 2,525 patients.
- Development of a predictive model for a composite endpoint including surgery, radiology, and death.
- Evaluation of the interaction between time to endoscopy and BleSev on death risk.
Main Results:
- Five independent factors identified: altered mental status, low systolic blood pressure, high blood urea nitrogen, hematemesis, and low hemoglobin.
- Three BleSev classes established: low (0-1 points), intermediate (3-4 points), and high (≥5 points).
- Death risk ranged from 1% (no factors) to 45.5% (all factors); risk increased with BleSev, largely independent of endoscopy timing, except for high-risk cases benefiting from early intervention.
Conclusions:
- A validated risk model for upper gastrointestinal bleeding severity (BleSev) has been established.
- Targeted endoscopic timing strategies based on BleSev are crucial for improving survival.
- Urgent endoscopic intervention may significantly benefit patients in the highest BleSev category.
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