Sa1471 Independent Predictors of Lesion Localization and Outcomes in Cirrhotic and Non-Cirrhotic Patients With Severe Hematochezia by Bivariate and Multivariate Analyses

Independent Predictors of Lesion Localization and Outcomes in Cirrhotic and Non-Cirrhotic Patients With Severe Hematochezia by Bivariate and Multivariate Analyses Marine Camus*, Dennis M. Jensen, Mary Ellen Jensen, Daniela Markovic, Jeffrey Gornbein CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Division of Digestive Diseases, UCLA Ronald Reagan Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Gastroenterology, Lariboisiere Hospital, APHP, University Paris 7, Paris, France; Gastroenterology Division, VA GLAHC, Los Angeles, CA; Department of Biomathematics, UCLA, Los Angeles, CA Background and Aims: Independent predictors of location and outcomes of cirrhotics vs. non-cirrhotics presenting with severe hematochezia have not been previously reported. The aims of the study were (1) to identify independent predictors of bleeding localization (upperGI, small bowel or colon) in cirrhotic and non-cirrhotic patients, (2) to identify predictors of outcomes (rebleeding, surgery and death) at 30 days after initial hemorrhage in patients with severe hematochezia, and (3) to determine if cirrhosis is a risk factor of 30 day outcomes. Methods: All consecutive patients with severe hematochezia admitted between June 1995 and June 2011 to our two tertiary referral academic medical centers were prospectively studied. Clinical, laboratory, endoscopic, and outcome results (rebleeding, surgery, and death) up to 30 days were studied. SAS was used for data management and analysis. Biand multivariate analyses were carried out to determine the association between cirrhosis and bleeding location, and then to find predictors of rebleeding, surgery or death in population of patients with severe hematochezia. Multivariate analyses were computed using two models (logistic regression and decision tree-CART). Results: 861 patients were included with160 (18.6 %) cirrhotics and 701 (81.4 %) non-cirrhotics. Cirrhosis was a predictor of upper gastrointestinal (UGI) location (OR 3.47, 95% CI 2.01-5.96 vs. colon, OR 4.15, 95% CI 1.57-11.00 vs. small bowel). The other independent risk factors for UGI vs. colon location were: recent history of hematemesis or melena (within 30 days), positive NG aspirate, prior UGI bleeding, and aspirin and/or NSAID use. At 30 days, outcomes in cirrhotics were significantly worse than those in non-cirrhotics, with higher rebleeding (23.1 % vs. 15.0 %, p 0.0122), surgery (14.4 % vs. 6.4 %, p 0.0008), and mortality (15.7 % vs. 4.1 %, p 0.0001) rates. Cirrhosis (OR 2.13, 95% CI 1.01-4.49) and inpatient start of bleeding (OR 5.62, 95% CI 2.83-11.13) were significant predictors of death at 30 day. Hematocrit less than 28 % (OR 2.21, 95% CI 1.42-3.44) and CURE prognostic score 3 (OR 3.37, 95% CI 2.18-5.19) were significant predictors of rebleeding at 30 days. Logistic regression and CART models were similar in accuracy ( 70 %) and in identifying cirrhosis as a predictor of UGI location of hemorrhage and of 30 day mortality. Conclusions: (1) Cirrhosis is an independent predictor of UGI location in patients admitted with severe hematochezia. (2) Cirrhosis is also an independent risk factor for 30 day mortality in patients admitted with severe hematochezia. (3) A cirrhosis diagnosis needs to be considered early in algorithms for management of severe hematochezia.This study was partially funded by NIH NIDDK CURE DDRC Grant (AM 41301) Human Studies CORE & also by a Clinical VA Merit Review Grant (D. Jensen).