Factors in UGI bleed

 Q: Which of the following is likely to be present in upper gastrointestinal (UGI) bleed? (select one)

A) blood urea nitrogen to serum creatinine ratio > 20

B) blood urea nitrogen to serum creatinine ratio > 30 

Answer:  B

Predictive factors for a UGI bleed can be described in Likelihood ratios (LR). Some of the important factors with their LR are below:

• patient's history of melena (LR 5.1-5.9) 
• melenic stool on examination (LR 25)
• blood or coffee-ground material on nasogastric (NG) lavage (LR 9.6)
• ratio of blood urea nitrogen (BUN) to serum creatinine (Cr) >  30 (LR 7.5)
• tachycardia (LR 4.9)
• hemoglobin less than 8 g/dL (LR 4.5-6.2)

#gastroenterology

Reference:

Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA 2012; 307:1072.