Is Blood Urea Concentration an Independent Predictor of Positive Endoscopic Findings in Presumed Upper Gastrointestinal Bleeding?

Chopra, Deepti; Rosenberg, Morgan; Moayyedi, Paul; Narula, Neeraj

doi:10.1159/000501549

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…But mean values of urea in a patient with varices and without varices were 63±45 and 37±24, respectively, showing a statistically significant correlation (p value-0.031). These findings were in concordance with a study done by Chopra et al [16] on blood urea concentration as an independent marker for the prediction of positive endoscopic findings in presumed upper gastrointestinal bleeding showed that urea may be used as a surrogate marker for the prediction of upper gastrointestinal bleed. But when we compared serum urea levels between large varices (Grade III/IV) (Group A) vs Grade I/II/No varices) (Group B), there was no statistically significant difference between the two groups, signifying that urea levels can be used to predict the presence of varices but cannot discriminate between groups with highgrade vs low-grade varices.…”

Section: Discussionsupporting

confidence: 93%

Serum Ammonia Levels as a Non-invasive Predictor of the Presence and Severity of Oesophageal Varices in Chronic Liver Disease Patients

Kumar¹,

Kansal²,

Chaudhary³

et al. 2023

Cureus

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BackgroundPortal hypertension leads to the formation of portosystemic collateral veins, of which esophageal varices (EV) are the most severe complications and have the greatest clinical impact. The possibility of identifying cirrhotic patients with varices by non-invasive tests is appealing, as they can lead to reduced healthcare costs and can be done in resource-limited settings. In this study, we investigated ammonia as a potential non-invasive predictor of EV. MethodsThis was a single-center cross-sectional observational study that was done at a tertiary health care hospital in north India. It included 97 chronic liver disease patients irrespective of etiology after excluding patients with portal vein thrombosis and hepatocellular carcinoma to participate in endoscopic screening for the presence of EV and correlate it with various non-invasive markers like serum ammonia levels, thrombocytopenia and aspartate aminotransferase to platelet ratio index (APRI ). On the basis of endoscopy, enrolled patients were divided into two groups, i.e., group A consisting of large varices (grade III and grade IV) and group B consisting of patients with low-grade varices and no varices (grade II, grade I, and no varices). ResultsThis study included 97 patients, out of which 81 patients have varices on endoscopy, and mean serum ammonia levels were found to be significantly higher in cases with varices (135 ±69.70 ) vs. those without varices (94±43) (p value=0.026). Further, on comparing serum ammonia values between patients with large varices (Grade III/IV) (Group A) with a mean value of 176 ± 83 vs. Grade I/II/No varices (Group B) with a mean value of 107±47, which were significantly higher in Group A patients (<0.001). In our study, we also found a correlation between blood urea level as a non-invasive predictor of varices, but no statistically significant relation was found between thrombocytopenia and APRI. ConclusionThis study found that serum ammonia can be used as a useful marker for the prediction of EV and can also be used to determine the severity of varices. Apart from ammonia, serum urea levels can also prove to be a good non-invasive marker for the prediction of varices although further multicentric studies are warranted to reach this conclusion.

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Section: Discussionsupporting

confidence: 93%

Serum Ammonia Levels as a Non-invasive Predictor of the Presence and Severity of Oesophageal Varices in Chronic Liver Disease Patients

Kumar¹,

Kansal²,

Chaudhary³

et al. 2023

Cureus

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“…Several studies have shown an association between urea levels and the severity of upper gastrointestinal bleedings. [37][38][39][40] Pathophysiologically, this link can be referred to as a gastrointestinal breakdown of blood components that leads to reabsorption of amino acids which in turn causes a rise of urea, the end product of amino acid metabolism. 40 Furthermore, high urea is a marker for renal hypoperfusion and consequentially an indicator of hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest that besides renal dysfunction, urea might reflect other factors associated with mortality in patients undergoing TIPS. Several studies have shown an association between urea levels and the severity of upper gastrointestinal bleedings 37–40 . Pathophysiologically, this link can be referred to as a gastrointestinal breakdown of blood components that leads to reabsorption of amino acids which in turn causes a rise of urea, the end product of amino acid metabolism 40 .…”

Section: Discussionmentioning

confidence: 99%

A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS ‐ Modified TIPS Score

Fürschuß

Rainer

Effenberger

et al. 2022

Liver International

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Background and aims:The high risk for severe shunting-related post-interventional complications demands a stringent selection of candidates for transjugular intrahepatic portosystemic shunt (TIPS). We aimed to develop a simple and reliable tool to accurately predict early post-TIPS mortality.Methods: 144 cases of TIPS implantation were retrospectively analysed. Using univariate and multivariate Cox regression analysis of factors predicting mortality within 90 days after TIPS, a score integrating urea, international normalized ratio (INR) and bilirubin was developed. The Modified TIPS-Score (MOTS) ranges from 0 to 3 points: INR >1.6, urea >71 mg/dl and bilirubin >2.2 mg/dl account for one point each.Additionally, MOTS was tested in an external validation cohort (n = 187) and its performance was compared to existing models.Results: Modified TIPS-Score achieved a significant prognostic discrimination reflected by 90-day mortality of 8% in patients with MOTS 0-1 and 60% in patients with MOTS 2-3 (p < .001). Predictive performance (area under the curve) of MOTS was accurate (c = 0.845 [0.73-0.96], p < .001), also in patients with renal insufficiency (c = 0.830 [0.64-1.00], p = .02) and in patients with refractory ascites (c = 0.949 [0.88-1.00], p < .001), which are subgroups with particular room for improvement of post-TIPS mortality prediction. The results were reproducible in the validation cohort. Conclusions:Modified TIPS-Score is a novel, practicable tool to predict post-TIPS mortality, that can significantly simplify clinical decision making. Its practical applicability should be further investigated.

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“…In a study in 2020 study reported that urea level was an independent predictor of positive endoscopic findings in upper GI bleeding and that early endoscopic intervention should be considered in patients with elevated urea levels. 7 Some studies have used the BUN/Creatinine ratio as an index to differentiate between upper and lower GI bleeding and have shown that a higher BUN/ Cr ratio is associated with a higher likelihood of upper GI bleeding. 8,9 In cases of ongoing bleeding in any area of the body, a decrease in hemoglobin levels is expected.…”

Section: Introductionmentioning

confidence: 99%

The predictive value of the urea/hemoglobin ratio for endoscopic treatment in patients with upper gastrointestinal bleeding

YEŞİL,

SEVİM

2023

J Med Palliat Care / JOMPAC / jompac

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Abstract Aims: Upper gastrointestinal bleeding develops due to various pathologies in a wide region, including esophagus, stomach, and duodenum. The clinical presentation is highly variable between patients and can rapidly deteriorate and even be fatal without follow-up. Medical agents, endoscopic interventions, and surgery may be required in the treatment of the patient, and a high blood transfusion may be required. Predicting which patients are more at risk and urgent than others is important for the correct treatment of patients. The urea/hemoglobin ratio can be a simple, rapidly applicable, and reliable indicator to predict the need for endoscopy. Methods: This was a single-center retrospective study in which 361 patients treated for upper gastrointestinal bleeding were investigated. Age and gender data, endoscopy records, and blood tests of the patients were analyzed within the scope of the study. Median UHR values were significantly higher in intensive care indication, endoscopic indications, and blood transfusion indications (p

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Is Blood Urea Concentration an Independent Predictor of Positive Endoscopic Findings in Presumed Upper Gastrointestinal Bleeding?

Cited by 6 publications

References 22 publications

Serum Ammonia Levels as a Non-invasive Predictor of the Presence and Severity of Oesophageal Varices in Chronic Liver Disease Patients

Serum Ammonia Levels as a Non-invasive Predictor of the Presence and Severity of Oesophageal Varices in Chronic Liver Disease Patients

A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS ‐ Modified TIPS Score

The predictive value of the urea/hemoglobin ratio for endoscopic treatment in patients with upper gastrointestinal bleeding

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