Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 12, Number 1, February 2019, pages 1-7


Lactic Acid Is an Independent Predictor of Mortality and Improves the Predictive Value of Existing Risk Scores in Patients Presenting With Acute Gastrointestinal Bleeding

Figure

Figure 1.
Figure 1. ROC curves comparing the original and modified Blatchford scores (top panel), Rockall pre-endoscope score (middle panel), and Rockall post endoscopic (complete) scores (bottom panel).

Tables

Table 1. Baseline Demographic Characteristics and Test Result of Patients With Acute Gastrointestinal Bleeding According to In-Patient Mortality Status
 
Survivors (n = 336)Non-survivors (n = 30)All (366)P value
Age (years)
  Mean (SD)70.5 (15.9)76.6 (16.2)70.9 (16)0.021
  Median (IQR)72 (20)80 (21)73 (21)
Gender148 (44%)14 (46.7%)162 (44.3%)0.782
  Female, n (%)
Systolic blood pressure (mm Hg), mean (SD)127.3 (27)116.0 (28.6)123.4 (27.5)0.035
Heart rate (beats/min), mean (SD)89.5 (21.3)86.7 (26.7)89.3 (21.8)0.747
Melena127 (37.8%)12 (40%)139 (38%)0.812
Syncope in last 7 days19 (5.7%)5 (16.7%)24 (6.6%)0.037
Altered mentation24 (7.1%)7 (23.3%)31 (8.5%)0.008
Comorbidities
  No major comorbidity65 (19.3%)2 (6.7%)67 (18.3%)< 0.0001
  Renal failure, liver failure, and/or disseminated malignancy120 (35.7%)22 (73.3%)142 (38.8%)
  Any comorbidity except renal failure, liver failure, and/or disseminated malignancy151 (44.9%)6 (20.0%)157 (42.9%)
Congestive heart failure74 (22%)10 (33.3%)84 (23%)0.158
Hepatic disease43 (12.8%)8 (26.7%)51 (13.9%)0.05
Albumin < 3g/dL55 (16.4%)15 (50%)70 (19.1%)< 0.0001
INR > 1.573 (21.7%)5 (16.7%)78 (21.3%)0.487
Lactic acid , peak (mmol/L), mean (SD)2.2 (1.7)5.8 (5.5)2.4 (2.2)< 0.0001
Hemoglobin(g/dL), mean (SD)10.4 (3)9.7 (2.7)10.3 (3)0.295
BUN(mg/dL), mean (SD)33.3 (22)41.5 (27)33.8 (22.8)0.058
Endoscopic diagnosis (n = 188)
  No lesion or stigmata of recent bleed41 (23.6%)2 (14.3%)43 (22.9%)0.316
  Malignancy of upper GI tract3 (1.7%)1 (7.1%)4 (2.1%)
  All other diagnosis130 (74.7%)11 (78.6%)141 (75%)
Hemorrhage stigmata (n = 189)67 (38.3%)11 (78.6%)78 (41.3%)0.003

 

Table 2. Clinical Risk Scores According to Inpatient Mortality Status
 
Risk scoresSurvivors (n = 336)Non-survivors (n = 30)P value
*Values are mean score (SD).
Blatchford score8 (4.6)10.7 (4.3)0.002
Rockall-pre-endoscopy3.6 (1.5)4.6 (1.3)0.001
Rockall-complete*5.3 (2.1)6.9 (1.3)0.004
AIMS651.87 (0.8)1.9 (0.8)0.683

 

Table 3. Binary Logistic Regression for the Prediction of In-Patient Mortality in Patients With Acute Gastrointestinal Bleeding
 
Odds ratio (OR)95% Confidence interval for ORP value
LowerUpper
Age1.071.021.11< 0.0001
BP1.010.991.030.37
Hepatic disease0.410.091.870.25
Charlson score
  (0) Reference0.04
  (2)0.550.093.230.51
  (3)2.480.4513.540.3
Syncope in last 7 days0.90.194.410.9
Altered mentation3.40.9811.780.05
Lactic acid level, peak1.511.261.82< 0.0001
BUN0.990.971.010.39
Albumin0.280.120.64< 0.0001

 

Table 4. Comparison Between Original Clinical Risk Scoring Systems and Modified Scoring System Incorporating Points (1, 2, or 3) for Lactic Acid ≥ 2.75 mmol/L
 
ScoreAreaP value95% Confidence intervalP value
Lower boundUpper bound
Blatchford score0.6520.0060.5570.747Blatchford score vs.
  L1-Blatchford0.6690.0020.5780.7600.005
  L2-Blatchford0.6880.0010.6000.7750.004
  L3-Blatchford0.7060.0000.6210.7920.003
Rockall Pre-Endoscopy0.6750.0010.5860.765Rockall pre-endoscopy vs.
  L1-Rockall pre-endoscopy0.7330.0000.6490.8180.003
  L2-Rockall pre-endoscopy0.7620.0000.6800.8440.007
  L3-Rockall pre-endoscopy0.7740.0000.6940.8540.012
Rockall Score-complete0.7420.0030.6330.850Rockall score-complete vs.
  L1-Rockall-complete0.7800.0000.6770.8830.040
  L2-Rockall-complete0.8010.0000.6980.9040.078
  L3-Rockall-complete0.8080.0000.7030.9130.129