Utility of blood urea nitrogen as a predictor of endoscopic hemostasis in patients with suspected acute non-variceal upper gastrointestinal bleeding

Choi, Nak Young; Cho, Young Mo; Wang, Il Jae; Yeom, Seok Ran; Park, Sung Wook

J Korean Soc Emerg Med > Volume 33(4); 2022 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2022;33(4): 346-354.

급성 비정맥류 상부위장관 출혈 의심 환자에서 내시경적 지혈술 예측에 있어 혈중 요소 수치의 유용성

최낙영

부산대학교병원 응급의학과

Utility of blood urea nitrogen as a predictor of endoscopic hemostasis in patients with suspected acute non-variceal upper gastrointestinal bleeding

Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea

Correspondence

Sung Wook Park ,Tel: 051-240-7503, Fax: 051-253-6472, Email: psu52156@naver.com,

Revised: October 1, 2021 Accepted: October 22, 2021. Published online: August 31, 2022.

ABSTRACT

Objective:
Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB).
Method:
The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared.
Results:
Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded.
Conclusion:
The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

Key words: Gastrointestinal hemorrhage; Blood urea nitrogen; Endoscopy; Endoscopic hemostasis