Prognostic value of fibrinolytic tests for hospital outcome in patients with acute upper gastrointestinal hemorrhage.

摘要

GOALS: We assessed the predictive value of fibrinolytic tests for hospital outcome in a prospective study of 84 nonconsecutive patients with acute upper gastrointestinal hemorrhage. STUDY: Six readily available parameters of activated fibrinolysis (fibrinogen, D-dimer, tissue plasminogen activator [TPA], plasminogen activator inhibitor type 1 [PAI-1], TPA--PAI-1 complexes, and plasmin-alpha 2-antiplasmin complexes) were tested for association with hospital outcome. Patients were divided into the following three groups: patients who survived and did not require transfusion or surgery, those who survived without surgery but required transfusion, and those who required surgery or died. RESULTS: Patients with adverse outcome (surgery and/or death) showed significantly higher plasma levels of D-dimer than patients with favorable outcome (p = 0.01). Plasma concentrations of D-dimer >300 ng/mL showed a 20.5% positive predictive value of adverse outcome, with a relative risk of 7.5 (95% CI: 1--57%). Patients who required transfusion showed significantly higher plasma levels of TPA (p = 0.01). A positive correlation between endoscopic bleeding stigmata and D-dimer in the subgroup of patients without liver cirrhosis was found (p = 0.02); however, in the multivariate logistic regression analysis the concentration of D-dimer did not appear as an independent predictor of adverse outcome. CONCLUSIONS: These findings are consistent with the role of increased local fibrinolysis in the digestive tract, particularly of D-dimer, in patients with upper gastrointestinal hemorrhage and adverse outcome. Accordingly, plasma fibrinolytic tests may constitute an appropriate prognostic marker in upper gastrointestinal bleeding.