582 CRP and BUN as Risk Factor for Complications in Patients With Upper Gastrointestinal Bleeding

Abstract

INTRODUCTION: Rebleeding and mortality were serious complications following upper gastrointestinal bleeding. We need to identify the risk factor of the complication for prevention and prompt treatment. This study aims to know the risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding. METHODS: A prospective analytic observational study was made in patients with upper gastrointestinal bleeding, who admitted to Sanglah General Hospital. Data of CRP and BUN was collected when the patients admitted to the hospital, and follow up was done in 6 weeks to see the complication. The data were analysed using the chi-square test. RESULTS: Sixty-eight patients admitted to the hospital with upper gastrointestinal bleeding were involved in this study. 2 patients loss of follow up, and the rest 66 patients were involved in the analysis. Range age of patients was 18-68 years old. Forty-six (69.7%) patients were male, and the rest 20 (30.3%) were female. Both variceal and nonvariceal upper gastrointestinal bleeding patients were involved in this study. Median of CRP was 4.61 (0.30-65.80) mg/L and CRP level >5 mg/L was defined as high risk for complication. Mean BUN 35.65 ± 34.45 mg/dL, and BUN >20 mg/dL was defined as high risk for complication. During follow up, 41 patients have a complication. Rebleeding occurred in 27 patient and mortality in 14 patients. The results of Chi-square test for CRP:X 2 = 16.0; P < 0.001; OR=9.67 (2.95-31.73); for BUN: X 2 = 6.70; P = 0.01; OR = 3.95 (1.36-11.43). CONCLUSION: Rebleeding and death is the major complication in a patient with upper gastrointestinal bleeding, both variceal and nonvariceal. It is crucial to identify the risk factor of complication to predict the outcome of the patients. In this study, we found CRP level > 5 mg/L and BUN level >20 mg/dL was a significant risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding. This result is supported by the previous study, that found the serum CRP was an independent risk factor for 30-day rebleeding in patients with acute nonvariceal upper gastrointestinal bleeding and study by Wu et al., observed BUN/Creatinine ratio of >30 was an independent risk factor for mortality. Identifying the risk factor for a bad outcome will guide us to manage and treat the patients. In conclusion, In this study CRP level >5 mg/L and BUN level >20 mg/dL was a significant risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding.