Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, USA.
Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, USA,
Dig Dis. 2020;38(1):77-84. doi: 10.1159/000501549. Epub 2019 Jul 16.
The test characteristics of blood urea concentration in the identification of upper gastrointestinal bleeding (UGIB) or high-risk endoscopic lesions have not been clearly determined. This study aimed to elucidate if urea independently correlates with the presence of positive endoscopic findings in cases of presumed UGIB and understand the diagnostic value of this parameter when assessing a patient with potential UGIB.
A retrospective cohort study was conducted at Hamilton Health Sciences hospitals examining patients who had upper endoscopy for presumed UGIB. Contingency tables were generated to determine the test characteristics of urea at different thresholds for prediction of UGIB. A crude OR was calculated for odds of bleeding being identified on endoscopy based on varying thresholds of urea, and adjusted ORs were calculated using logistic regression modelling.
Variables significantly associated with detecting a source of GI bleeding at endoscopy included increase in urea (OR 1.06, 95% CI 1.01-1.09), male gender (OR 2.02, 95% CI 1.08-3.77), presence of melena (OR 2.37, 95% CI 1.06-5.33), and hematemesis (OR 3.88, 95% CI 1.70-8.83), when adjusted for other covariates. The odds of identifying UGIB at endoscopy in patients with urea ≥10 mmol/L was 3.73 (95% CI 1.90-7.31) times higher than for patients with urea <10 mmol/L.
Urea level is an independent predictor of positive endoscopic findings in presumed UGIB, and urea ≥10 mmol/L may be a useful threshold to help guide clinicians towards clinically significant bleeding that could warrant early endoscopic evaluation.
血液尿素浓度在识别上消化道出血（UGIB）或高危内镜下病变中的检测特征尚未明确。本研究旨在阐明在疑似 UGIB 患者中，尿素是否与内镜阳性发现的存在独立相关，并了解在评估疑似 UGIB 患者时，该参数的诊断价值。
对汉密尔顿健康科学医院进行的回顾性队列研究，检查了因疑似 UGIB 而行上消化道内镜检查的患者。生成列联表以确定不同尿素阈值下预测 UGIB 的检测特征。根据尿素的不同阈值，计算出内镜下发现出血的优势比（OR），并使用逻辑回归模型计算调整后的 OR。
与在内镜下检测到 GI 出血来源显著相关的变量包括尿素升高（OR 1.06，95%CI 1.01-1.09）、男性（OR 2.02，95%CI 1.08-3.77）、黑便（OR 2.37，95%CI 1.06-5.33）和呕血（OR 3.88，95%CI 1.70-8.83），在调整其他协变量后。尿素≥10mmol/L 的患者在内镜下识别 UGIB 的可能性是尿素<10mmol/L 的患者的 3.73 倍（95%CI 1.90-7.31）。
尿素水平是疑似 UGIB 内镜阳性发现的独立预测因子，尿素≥10mmol/L 可能是一个有用的阈值，可以帮助指导临床医生识别可能需要早期内镜评估的有临床意义的出血。
