Study of the benefit of blood urea nitrogen/creatinine ratio and some other parameters to detect site, cause, and severity of gastrointestinal hemorrhage noninvasively

Abstract

Background and aim Gastrointestinal (GI) bleeding is a common medical condition that may lead to emergent endoscopy. The aim of our study was to design pre-endoscopic scores for GI bleeding to clarify the source of GI bleeding, to differentiate variceal and nonvariceal cases, and to identify complications and high-risk patients requiring urgent clinical management. Patients and methods One hundred patients with hematochezia or melena were enrolled in this study. Blood urea nitrogen (BUN)/creatinine ratio score, upper GI bleeding etiological score, C-WATCH score, and Glasgow-Blatchford score (GBS) were calculated. Upper GI endoscopy was performed by the consultant within 72 h, and lower endoscopy was done if indicated. Results This prospective study was done on 83 patients presented with upper gastrointestinal tract (GIT) bleeding and 17 patients presented with lower GIT bleeding. BUN/creatinine ratio was significantly higher in upper than lower GIT bleeding (P=0.019). Sensitivity of upper GI score was 45%, specificity was 86.96%, positive predictive value was 90.0%, and negative predictive value was 37.7%, with accuracy of 81.6%. Sensitivity and specificity of C-WATCH score were 38.33 and 78.26, respectively, and for GBS were 61.6 and 69.5%, respectively. Conclusion BUN/creatinine ratio had higher effectiveness in detecting upper than lower GI bleeding. Upper GI etiological score was significantly higher in diagnosis of variceal bleeding than nonvariceal bleeding. GBS is highly sensitive but not specific to anticipate complications of upper GIT bleeding; however, C-WATCH score can anticipate severity and complications of upper GI bleeding.