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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding
Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Yoshinori Shirai, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
Minoru Tomizawa, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Fuminobu Shinozaki, Department of Radiology, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Rumiko Hasegawa, Yoshinori Shirai, Department of Surgery, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Yasufumi Motoyoshi, Department of Neurology, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Takao Sugiyama, Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Shigenori Yamamoto, Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Naoki Ishige, Department of Neurosurgery, National Hospital Organization Shimoshizu Hospital, Chiba 284-0003, Japan
Author contributions: Tomizawa M and Shinozaki F performed upper endoscopy, constructed tables and figures, and wrote the manuscript; Hasegawa R and Shirai Y performed colonoscopy and upper endoscopy; Motoyoshi Y, Sugiyama T and Yamamoto S analyzed the data; and Ishige N supervised the investigation.
Ethics approval: Judgment of the research proposal by Institutional Ethics Committee Principle Investigator, Minoru Tomizawa.
Informed consent: All study participants or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Data sharing: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Minoru Tomizawa, MD, PhD, Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, 934-5 Shikawatashi, Yotsukaido City, Chiba 284-0003, Japan.
nihminor-cib@umin.ac.jp
Telephone: +81-43-4222511 Fax: +81-43-4213007
Received: November 4, 2014
Peer-review started: November 7, 2014
First decision: December 11, 2014
Revised: December 18, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: May 28, 2015
Processing time: 207 Days and 4 Hours
AIM: To distinguish upper from lower gastrointestinal (GI) bleeding.
METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively (3296 upper endoscopy, and 1520 colonoscopy). Seventy-six patients had upper GI bleeding (Upper group) and 65 had lower GI bleeding (Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiver-operator characteristic (ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding.
RESULTS: Hemoglobin (P = 0.023), total protein (P = 0.0002), and lactate dehydrogenase (P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen (BUN) was higher in the Upper group than in the Lower group (P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vs lower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/dL, with a specificity of 93.0%.
CONCLUSION: The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL.
Core tip: Differentiation of upper vs lower gastrointestinal (GI) bleeding is crucial. Laboratory test variables were investigated for their ability to distinguish upper from lower GI bleeding from retrospective analysis. Total protein, hemoglobin, and lactate dehydrogenase were lower and blood urea nitrogen (BUN) was higher in patients with upper GI bleeding. The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL, with a specificity of 93.0%.
