JOMPAC

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

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Original Article
Urea-to-hemoglobin ratio for patients with upper gastrointestinal bleeding
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. The accurate identification of patients who are at a higher risk and require immediate attention is crucial for the appropriate management of patient care. The ratio of urea to hemoglobin (UHR) has been identified as a potentially valuable tool for determining the necessity of endoscopy due to its simplicity, quick applicability, and reliability.
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<0.05).
Results: The majority of patients were male, with 72.3%. The median age was 56 years (15-96). Peptic ulcer (70.9%) was the most common etiologic cause, and angioectasia (6.65%) was the second most common etiologic cause. Intensive care follow-up was required in 29.1%, erythrocyte replacement in 36.01%, and endoscopic treatment in 46.81% of patients. 13 patients died (3.6%). The median value was 58 for urea, 10.50 for hemoglobin and 5.75 for UHR.
Conclusion: Upper gastrointestinal bleeding is a variable and rapidly deteriorating clinical entity. Patients may not always be encountered under ideal conditions and may need to be managed with limited resources. Therefore, there is a need for easy-to-access, rapid, and reliable auxiliary techniques to differentiate patients who may need urgent treatment and interventions from others. Urea and Urea/hemoglobin ratio fulfill these requirements, and their significance in terms of upper gastrointestinal bleeding should be investigated.


1. Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factorsfor upper gastrointestinal bleeding. Gastrointest Endosc Clin NAm. 2015;25(3):415-428.
2. Nable JV, Graham AC. Gastrointestinal bleeding. Emerg Med ClinNorth Am. 2016;34(2):309-325.
3. Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis andmanagement of upper gastrointestinal bleeding. Am FamPhysician. 2012;85(5):469-476.
4. Kiringa SK, Quinlan J, Ocama P, Mutyaba I, Kagimu M.Prevalence, short term outcome and factors associated withsurvival in patients suffering from upper gastrointestinal bleedingin a resource limited-setting, the case of Mulago hospital inKampala, Uganda. Afr Health Sci. 2020;20(1):426-436.
5. Nahon S, Hag&egrave;ge H, Latrive JP, et al. Epidemiological andprognostic factors involved in upper gastrointestinal bleeding:results of a French prospective multicenter study. Endoscopy.2012;44(11):998-1008.
6. Tomizawa M, Shinozaki F, Hasegawa R, et al. Patientcharacteristics with high or low blood urea nitrogen inupper gastrointestinal bleeding. World J Gastroenterol.2015;21(24):7500-7505.
7. Chopra D, Rosenberg M, Moayyedi P, Narula N. Is Blood ureaconcentration an independent predictor of positive endoscopicfindings in presumed upper gastrointestinal bleeding?. Dig Dis.2020;38(1):77-84.
8. Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of theblood urea nitrogen/creatinine ratio in gastrointestinal bleeding.Am J Emerg Med. 1999;17(1):70-72.
9. Urashima M, Toyoda S, Nakano T, et al. BUN/Cr ratio as anindex of gastrointestinal bleeding mass in children. J PediatrGastroenterol Nutr. 1992;15(1):89-92.
10. Samuel R, Bilal M, Tayyem O, Guturu P. Evaluation andmanagement of Non-variceal upper gastrointestinal bleeding. DisMon. 2018;64(7):333-343.
11. Falc&atilde;o D, Alves da Silva J, Pereira Guedes T, Garrido M, NovoI, Pedroto I. The current portrayal of non-variceal uppergastrointestinal bleeding in a Portuguese Tertiary Center. GE PortJ Gastroenterol. 2021;28(6):392-397.
12. Tomizawa M, Shinozaki F, Hasegawa R, et al. Low hemoglobinlevels are associated with upper gastrointestinal bleeding. BiomedRep. 2016;5(3):349-352.
13. Hearnshaw SA, Logan RF, Palmer KR, Card TR, Travis SP,Murphy MF. Outcomes following early red blood cell transfusionin acute upper gastrointestinal bleeding. Aliment Pharmacol Ther.2010;32(2):215-224.
14. Sasaki Y, Abe T, Kawamura N, et al. Prediction of the need foremergency endoscopic treatment for upper gastrointestinalbleeding and new score model: a retrospective study. BMCGastroenterol. 2022;22(1):337.
15. Shung DL, Au B, Taylor RA, et al. Validation of a machine learningmodel that outperforms clinical risk scoring systems for uppergastrointestinal bleeding. Gastroenterology. 2020;158(1):160-167.
16. Marmo R, Koch M, Cipolletta L, et al. Predictive factors ofmortality from nonvariceal upper gastrointestinal hemorrhage:a multicenter study. Am J Gastroenterol. 2008;103(7):1639-1648.
17. Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf).2023;11:goad011.
18. de Groot NL, van Oijen MG, Kessels K, et al. Reassessment ofthe predictive value of the Forrest classification for peptic ulcerrebleeding and mortality: can classification be simplified?Endoscopy. 2014; 46 (01): 46-52.
19. Kim JS, Kim BW, Kim DH, et al. Guidelines for nonvariceal uppergastrointestinal bleeding. Gut Liver. 2020;14(5):560-570.
20. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosisand management of nonvariceal upper gastrointestinalhemorrhage (NVUGIH): European Society of GastrointestinalEndoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(03):300-332.
Volume 4, Issue 5, 2023
Page : 499-504
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