Copyright ©The Author(s) 2019.
World J Gastroenterol. Jan 7, 2019; 25(1): 69-84
Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.69
Table 1 Risk factors and odds ratios for various outcomes according to 11 studies[7,8,20-28]
Severe/recurrent bleedingIn-hospital complications3Adverse outcomes4Mortality
Patient characteristic
Older age2.31-4.214.92
Male sex6--1.5-1.6
Lower body mass index---2.0
Charlson index > 2 or ≥ 21.7-1.9--3.0
Unstable comorbid diseases-2.9--
Congestive heart failure---1.5
Cardiovascular disease6---
Metastatic cancer---5.0
Chronic kidney disease---1.8-2.2
Liver disease---1.9
Chronic pulmonary disease---1.6
History of colonic diverticulosis and/or angiodysplasia6--6
Presenting symptom
Syncope / altered mental status2.5-3.32.0-6
No diarrhea2.2---
No abdominal tenderness2.4-3.0---
Ongoing bleeding-3.1--
Bleeding in the first 4 h2.3---
NSAIDs (non-aspirin)12.5--1.5
Antiplatelet drugs (non-aspirin)2.0---
Physical examination
Blood pressure ≤ 100 or ≤ 115 mmHg2.3-3.53.0-6
Heart rate ≥ 100/min3.7---
Abnormal vital signs after 1 h4.3---
Abnormal hemodynamic parameters--2.1-
Gross blood on rectal examination3.5-3.9--6
Laboratory data
Hemoglobin < 10 g/dL3.6---
Albumin < 3.0 or < 3.8 g/dL2.0-2.9--2.9
Creatinine > 150 or > 133 µmol/L6-10.36
Hematocrit < 35% or < 30%4.7-6.3--6
Prothrombin time > 1.2 times control-2.0--
Clinical course
Intestinal ischemia---3.5
Coagulation defects---2.3
Blood transfusion---1.6-2.8
Need for intervention5---2.3-2.4
In-hospital onset LGIB---2.4
Table 2 Risk scoring systems for severe acute lower gastrointestinal bleeding which have been validated
Derivation studyOutcomesRisk factorsROC-AUCValidation study
Strate et al[21]Severe bleedingSyncope0.76Prospective cohort (n = 275)
(n = 252)(continuous and/or recurrent bleeding)No abdominal tendernessROC-AUC: 0.75
Aspirin use
Heart rate ≥ 100/min
Systolic blood pressure ≤ 115 mmHg
Bleeding per rectum in the first 4 h
Charlson comorbidity index > 2
Das et al[22]Rebleeding(19 factors)0.92Prospective cohort (n = 142)
(n = 120)Need for interventionAge0.93
Artificial neural network based modelIn-hospital mortalityComorbidity (5 factors)0.95
History (4 factors)
Features at presentation (2 factors)
Features at initial assessment (2 factors)
Initial laboratory data (5 factors)
Aoki et al[24]Severe bleeding(NOBLADS)0.77Prospective cohort (n = 161)
(n = 439)(Continuous and/or recurrent bleeding)NSAIDs useROC-AUC: 0.76
No diarrheaRetrospective cohort (n = 511)
No abdominal tendernessROC-AUC: 0.74
Blood pressure (systolic) ≤ 100 mmHg
Albumin level < 3.0 g/dL
Antiplatelet drugs use (non-aspirin)
Disease score ≥ 21
Oakland et al[27]Safe dischargeAge0.84Prospective cohort (n = 288)
(n = 2336)(Absence of death, rebleeding, intervention, blood transfusion,Male sexROC-AUC: 0.79
or 28 d readmission)Blood on rectal examination
Heart rate
Systolic blood pressure
Hemoglobin level
Previous LGIB admission
Sengupta et al[28]30 d mortalityAge0.81Retrospective cohort (n = 2060)
(n = 4044)DementiaROC-AUC: 0.72
Metastatic cancer
Chronic kidney disease
Chronic pulmonary disease
Anticoagulant use
Hematocrit level
Albumin level
Table 3 Utility of early colonoscopy compared with elective colonoscopy according to randomized controlled trials and meta-analyses
StudyStudy designSample sizeBleeding source localizationEndoscopic interventionSurgery requiredRebleedingLength of stayAdverse eventsMortality
Green et al[41]RCT11002.6 (1.1-6.2)4-NSNSNSNSNS
Laine et al[42]RCT272NS--NSNS--
Sengupta et al[44]Meta-analysis39012.97 (2.11-4.19)43.99 (2.59-6.13)4NSNS--NS
Kouanda et al[43]Meta-analysis324,396NS1.70 (1.08-2.67)4-NS-NSNS
Seth et al[45]Meta-analysis323,419SRH detection 2.85 (1.90-4.28)4NSNSNSNS-NS
Table 4 Clinical significance of performing contrast-enhanced computed tomography before colonoscopy for colonic diverticular bleeding
StudyStudy designSample size1Detection rate of extravasation on CT (%)SRH detection rate on CS after extravasation on CT (%)SRH detection rate on CS after no extravasation on CT (%)Predictors for extravasation on CT
Obana et al[57]Prospective52155036History of diverticular bleeding
Within 2 h of last hematochezia
Nakatsu et al[54]Retrospective346306820-
Nagata et al[53]Retrospective77316338History of diverticular bleeding
Sugiyama et al[55]Retrospective55366031-
Wada et al[118]Retrospective1002370--
Umezawa et al[56]Prospective202257618Within 4 h of last hematochezia