Gastroduodenal Ulcer Bleeding: The Prognosis of Rebleeding

Abstract

Purposes: The study's purpose was to develop a prognostic scale for identifying patients at high or low risk of recurrent ulcer bleeding (RB). Methods: To identify the factors influencing RB, a retrospective single-centre study of 240 patients with ulcerative bleeding was carried out. The first group included 52 patients with RB, the second group included 188 patients who did not have RB. The authors identified criteria associated with the development of recurrent ulcerative bleeding. The identified criteria were included in the recurrent bleeding prognostic scale. To assess the quality of the prognosis of the developed predictive system and compare it to analogues, a single-centre retrospective study was carried out, which included 100 patients with ulcerative bleeding. The efficiency of the elaborated predictive system was compared to the mGBS and RS scales using the ROC-analysis approach. Results: The following criteria influenced the development of rebleeding: shock index, the number of erythrocytes, urea and total blood protein, ulcer localization along the lesser curvature of the stomach and the posterior wall of the duodenum, Type 2A, 2C, and 3 hemostasis according to Forrest. The developed scale demonstrated a higher quality of the RB prognosis in comparison with the mGBS and RS (AUROC - 0.877, 0.784, and 0.731, respectively). The sensitivity was 90.5%, the specificity was 78.5%. Conclusion: The developed scale can be used to identify patients with a low or high risk of recurrent ulcer bleeding. With further study of the effectiveness of the scale, it is possible to shift the threshold value for changing the indicators of specificity and sensitivity.

Keywords

• ulcerative gastroduodenal bleeding
• rebleeding
• risk assessment
• prognostic scale