Brief Article
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World J Gastroenterol. Feb 7, 2014; 20(5): 1311-1317
Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1311
Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding
Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Akira Togawa, Yoshinori Shirai, Noboru Ichiki, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Makoto Sueishi
Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Fuminobu Shinozaki, Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Rumiko Hasegawa, Akira Togawa, Yoshinori Shirai, Noboru Ichiki, Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Yasufumi Motoyoshi, Department of Neurology, National Hos- pital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Takao Sugiyama, Makoto Sueishi, Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Shigenori Yamamoto, Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido City, Chiba 284-0003, Japan
Author contributions: Tomizawa M, Shinozaki F, and Hasegawa R performed upper gastrointestinal endoscopy and wrote the manuscript; Togawa A, Shirai Y and Ichiki N performed surgery; Motoyoshi Y, Sugiyama T, Yamamoto S, and Sueishi M analyzed statistically.
Correspondence to: Minoru Tomizawa, MD, PhD, Head, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, 934-5 Shikawatashi, Yotsukaido City, Chiba 284-0003, Japan. nihminor-cib@umin.ac.jp
Telephone: +81-43-4222511 Fax: +81-43-4213007
Received: July 23, 2013
Revised: September 1, 2013
Accepted: September 15, 2013
Published online: February 7, 2014
Abstract

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.

Keywords: Receiver operating characteristic, Area under curve, Sensitivity, Specificity, Gastrointestinal bleeding

Core tip: Mortality rate of upper gastrointestinal (GI) bleeding is approximately 10%. Early upper gastrointestinal endoscopy significantly reduces mortality. We attempted to search for predictors of bleeding. Patient records were analyzed retrospectively. 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. Predictors for upper GI bleeding were hemoglobin (Hb) < 11.7 g/dL, reduction rate in the Hb > 21.3% and an increase in the C-reactive protein > 100%, 3 mo before endoscopy.