Reduced hemoglobin and increased C-reactive protein are associated with upper gastrointestinal bleeding

Table 1 Endoscopic diagnosis and patient number

Diagnosis	Number of patients	Number of patients with bleeding	Forrest classification
			1a	1b	2a	2b
Gastric ulcer	38	12	1	1	5	5
Duodenal ulcer	9	3	0	1	2	0
AGML	1	1	1	0	0	0
Gastric cancer	5	1	0	0	1	0
Esophageal varix	1	0	NA	NA	NA	NA
Gastritis	50	0	NA	NA	NA	NA
Esophageal hiatus hernia	2	0	NA	NA	NA	NA
Gastric polyp	5	0	NA	NA	NA	NA
Submucosal tumor	1	0	NA	NA	NA	NA
Normal	45	0	NA	NA	NA	NA
Total	157	17	2	2	8	5

AGML: Acute gastric mucosal lesion; NA: Not applicable.

Table 2 Laboratory data of each disease

Diagnosis	WBC count (/μL)	Hb (g/dL)	CRP (mg/dL)	BUN (mg/dL)	Cr (mg/dL)	BUN/Cr
Gastric ulcer	8080 ± 4104	10.4 ± 3.2	1.17 ± 1.43	23.3 ± 14.1	1.01 ± 0.44	31.7 ± 38.4
Duodenal ulcer	5520 ± 729	10.8 ± 2.7	0.28 ± 0.21	11.0 ± 5.5	0.80 ± 0.14	14.9 ± 10.2
AGML	6600	4.8	0.1	20.7	0.9	23
Gastric cancer	5860 ± 1132	11.1 ± 2.3	0.17 ± 0.11	16.1 ± 3.2	0.80 ± 0.16	20.5 ± 4.7
Esophageal varix	4700	10.1	0.13	21.7	0.8	27.1
Gastritis	6073 ± 2032	13.4 ±1.9	0.23 ± 0.22	14.5 ±5.4	0.81 ± 0.18	18.7 ± 6.4
Esophageal hiatus hernia	8350 ± 495	11.8 ± 1.1	1.45 ± 1.77	23.5 ± 4.9	1.30 ± 0.71	20.0 ± 7.07
Gastric polyp	6480 ± 1136	13.3 ± 0.5	0.95 ± 1.20	13.4 ± 4.6	0.78 ± 0.08	17.0 ± 4.6
Submucosal tumor	5000	12	1	20	0.6	33.3
Normal	5865 ± 1516	13.3 ± 1.6	0.64 ± 0.81	14.4 ± 2.1	0.77 ± 0.19	18.4 ± 4.3

WBC: White blood cell; Hb: Hemoglobin; CRP: C-reactive protein; BUN: Blood urea nitrogen; Cr: Creatinine; AGML: Acute gastric mucosal lesion.

Table 3 Comparison between bleeding (+) and (-) around the day of endoscopy

Laboratory data	Bleeding (-)		Bleeding (+)		Wilcoxon (P value)
	Mean	95%CI	Mean	95%CI
WBC count (/μL)	6370	5946-6795	6700	5613-7786	0.341
Hb (g/dL)	12.8	12.5-13.3	8.4	6.9-9.8	< 0.0001
CRP (mg/dL)	0.50	0.346-0.656	1.37	0.29-2.44	0.009
BUN (mg/dL)	16.4	14.6-18.1	22.5	15.4-29.7	0.096
Cr (mg/dL)	0.83	0.78-0.88	0.92	0.74-1.10	0.302
BUN/Cr	22.0	17.6-26.3	25.1	17.4-32.8	0.196

Bleeding (-), patients not diagnosed as 1a, 1b, 2a, or 2b by Forrest classification; bleeding (+), patients diagnosed as 1a, 1b, 2a, and 2b.Wilcoxon: Wilcoxon signed rank test; CI: Confidence interval; WBC: White blood cell; Hb: Hemoglobin; CRP: C-reactive protein; BUN: Blood urea nitrogen; Cr: Creatinine.

Table 4 Area under curve and threshold around the day of endoscopy

Laboratory data	AUC	Threshold	Sensitivity	Specificity
WBC count	0.573	5600 (/μL)	70.5%	46.4%
Hb	0.902	11.7 (g/dL)	94.1%	77.1%
CRP	0.722	0.5 (mg/dL)	70.5%	73.0%
BUN	0.635	20.7 (mg/dL)	52.9%	85.0%
Cr	0.580	1.20 (mg/dL)	35.3%	94.9%
BUN/Cr	0.605	23.0	58.8%	29.9%

AUC: Area under curve; WBC: White blood cell; Hb: Hemoglobin; CRP: C-reactive protein; BUN: Blood urea nitrogen; Cr: Creatinine; BUN/Cr: The ratio of BUN divided by Cr.

Table 5 Area under curve and threshold of the rate of change rate

Laboratory data	AUC	Threshold	Sensitivity	Specificity
WBC count	0.577	6.0%	64.7%	55.3%
Hb	0.851	-21.3%	76.4%	82.6%
CRP	0.901	100%	100%	82.5%
BUN	0.592	50.3%	58.8%	89.6%
Cr	0.527	-14.3%	35.3%	90.4%

AUC: Area under curve; WBC: White blood cell; Hb: Hemoglobin; CRP: C-reactive protein; BUN: Blood urea nitrogen; Cr: Creatinine.