The Change Of Clinical Characteristics Of Upper Gastrointestinal Bleeding In Past Decade And The Prediction Of Risk Factors Of Upper Gastrointestinal Bleeding

Aim:To explore the development and clinical features of upper gastrointestinal bleeding(UGIB)in this region.Then we want to evaluate the diagnostic efficacy of PLT,19 non-invasive scores in Predicting largeEsophageal varices(EV)in patients with liver cirrhosis.Method:Retrospectively collected clinical data of 4088 patients with upper gastrointestinal bleeding hospitalized in the first hospital of jilin university between January 2006 and December 2015.All patients had undergone upper gastrointestinal endoscopic examination to identify the etiology of UGIH.Then we comparative analysis on the etiology distribution,onset month,patient's age and gender of UGIB in this region.Then the clinical data of 162 liver cirrhosis patients hospitalized in the Department of Hepatology of our hospital,who had undergone endoscopy and had a tendency to UGIB,were retrospectively analyzed.All patients were divided into no large-EV group and large-EV group.Child classification,APRI,AAR,GPRI,FIB-4,S-index,King's score,Fibro-Q score,GUCI,Fibro-alpha score,Age platelet count index,FI,Globulin-albumin ratio,RPR,Study score or Doha score,Lok score,FCI,API,Pohl score,Globulin-platelet index,and a new model established by the multiple Logistic regression analysis were calculated to determine their performances in predicting large-EV for all patients.The correlation of those no-invasive models with EV was used Spearman rank correlation.The receiver operating characteristic(ROC)curve were used to evaluate the values of those models in the diagnosis of EV for patients of liver Cirrhosis,posthepatitic cirrhosis,and Hepatitis B liver cirrhosis.Results:Of the 4088 patients,who had undergone endoscopic examination to identify the etiology of UGIH,3130 were male,958 were female,male /female ratio is 3.3:1,The mean age was 45.35±21.69 years.The top five most common etiology of UGIH were peptic ulcer(1996 cases,48.8%),esophageal gastric varices(1497 cases,36.7%),gastric cancer(173 cases,4.2%),Mallory-Weiss syndrome(124 cases,3%),and duodenitis(66 cases,1.6%).Compared to the previous five years(2006-2010),the proportion of Peptic ulcer bleeding increased in the latter five years(2011-2015),while the proportion of Variceal Bleeding decreased(X2= 24.939,p <0.001)).The most common month of the onset of UGIH were October(477 cases,11.7%),September(392 cases,9.6%).The most common age distribution of the onset of UGIH were 51 to 60 years old(28.1%),41 to 50 years old(21.5%),and 61-70(20.4%).Of all 162 patients,who had undergone endoscopy and had a tendency to UGIB,large-EV were presented in 64 patients and no large-EV were shown in 98 patients.WBC,PT,and PLT were Included into the Logistic regression,which was named by PWP.GPRI,S-index,and Globulin-albumin ratio were no correlation with EV grade.The AUROCs of PWP for the prediction of large-EV was more than 0.8 in patients both of liver Cirrhosis,posthepatitic cirrhosis,and Hepatitis B liver cirrhosis.In patients of liver Cirrhosis,the AUROCs of another non-invasive scores,for the prediction of large-EV range from 0.610 to 0.790.In patients of posthepatitic cirrhosis,the AUROCs of another non-invasive scores,for the prediction of large-EV range from0.596-0.774,excepted API.In patients of Hepatitis B liver cirrhosis,the AUROCs,for the prediction of large-EV of non-invasive scores range from 0.540-0.811,excepted FCI,AAR,Fibro-alpha,and API.Conclusion:Peptic ulcer bleeding is still the most common etiology of UGIH.in the past decade.the proportion of Variceal Bleeding decreased obviously in the latter five years(2011-2015).UGIH was more likely to happen in October in male,especially for people between 51 and 60 years of age in this region.PWP had high diagnostic accuracy in predicting the presence of large EV.However,GPRI,S-index,and Globulin-albumin ratio were irrelevant to EV grade.Excepted API can not used to predict the presence of large EV in posthepatitic cirrhosis patients group and FCI,AAR,Fibro-alpha,and API can not used to predict the presence of large EV in Hepatitis B liver cirrhosis group,another non-invasive scores had low to moderate diagnostic accuracy in predicting the presence of large EV.