Early predictors of severity in acute lower intestinal tract bleeding

Background: Identification of high-risk patients with lower intestinal tract bleeding (LIB) is challenging, and prognostic factors have not been clearly defined. The aim of this study was to determine risk factors for severe acute LIB. Methods: A total of 252 consecutive patients admitted with acute LIB were identified. Data were collected on 24 clinical factors available in the first 4 hours of evaluation. The outcome was severe bleeding, which was defined as continued bleeding within the first 24 hours of hospitalization (transfusion of greater than or equal to2 units of blood and/or hematocrit decrease of greater than or equal to20%) and/or recurrent bleeding after 24 hours of stability (additional transfusions, further hematocrit decrease of greater than or equal to20%, or readmission for LIB within 1 week of discharge). Results: Severe LIB occurred in 123 patients (49%). Independent correlates of severe bleeding were as follows: heart rate, greater than or equal to100/min (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.78-7.57); systolic blood pressure, less than or equal to115 mm Hg (OR, 3.45; 95% CI, 1.54-7.72); syncope (OR, 2.82; 95% CI, 1.06-7.46); nontender abdominal examination (OR, 2.43; 95% CI, 1.22-4.85); bleeding per rectum during the first 4 hours of evaluation (OR, 2.32; 95% CI, 1.28-4.20); aspirin use (OR, 2.07; 95% CI, 1.12-3.82); and more than 2 active comorbid conditions (OR, 1.93; 95% CI, 1.08-3.44). Conclusion: Clinical data available on initial evalua tion can be used to identify patients at risk for severe LIB, who may benefit most from urgent intervention.