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Lisa L. Strate, MD, MPH; E. John Orav, PhD; Sapna Syngal, MD, MPH

Arch Intern Med. 2003;163:838-843.

Background  Identification of high-risk patients with lower intestinal tract bleeding (LIB) is challenging, and prognostic factors have not been clearly defined. The aim of this study was to determine risk factors for severe acute LIB.

Methods  A total of 252 consecutive patients admitted with acute LIB were identified. Data were collected on 24 clinical factors available in the first 4 hours of evaluation. The outcome was severe bleeding, which was defined as continued bleeding within the first 24 hours of hospitalization (transfusion of 2 units of blood and/or hematocrit decrease of 20%) and/or recurrent bleeding after 24 hours of stability (additional transfusions, further hematocrit decrease of 20%, or readmission for LIB within 1 week of discharge).

Results  Severe LIB occurred in 123 patients (49%). Independent correlates of severe bleeding were as follows: heart rate, 100/min (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.78-7.57); systolic blood pressure, 115 mm Hg (OR, 3.45; 95% CI, 1.54-7.72); syncope (OR, 2.82; 95% CI, 1.06-7.46); nontender abdominal examination (OR, 2.43; 95% CI, 1.22-4.85); bleeding per rectum during the first 4 hours of evaluation (OR, 2.32; 95% CI, 1.28-4.20); aspirin use (OR, 2.07; 95% CI, 1.12-3.82); and more than 2 active comorbid conditions (OR, 1.93; 95% CI, 1.08-3.44).

Conclusion  Clinical data available on initial evaluation can be used to identify patients at risk for severe LIB, who may benefit most from urgent intervention.

From the Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Dana Farber Cancer Institute, and Harvard Medical School (Drs Strate and Syngal), and Department of General Medicine, Primary Care Department of Biostatistics, and Department of Biostatistics, Harvard School of Public Health (Dr Orav), Boston, Mass. The authors have no relevant financial interest in this article.

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