We assessed the predictive value of fibrinolytic tests for hospital outcome in a prospective study of 84 nonconsecutive patients with acute upper gastrointestinal hemorrhage.
Six readily available parameters of activated fibrinolysis (fibrinogen, D-dimer, tissue plasminogen activator [TPA], plasminogen activator inhibitor type 1 [PAI-1], TPA–PAI-1 complexes, and plasmin-alpha 2-antiplasmin complexes) were tested for association with hospital outcome. Patients were divided into the following three groups: patients who survived and did not require transfusion or surgery, those who survived without surgery but required transfusion, and those who required surgery or died.
Patients with adverse outcome (surgery and/or death) showed significantly higher plasma levels of D-dimer than patients with favorable outcome (p = 0.01). Plasma concentrations of D-dimer >300 ng/mL showed a 20.5% positive predictive value of adverse outcome, with a relative risk of 7.5 (95% CI: 1–57%). Patients who required transfusion showed significantly higher plasma levels of TPA (p = 0.01). A positive correlation between endoscopic bleeding stigmata and D-dimer in the subgroup of patients without liver cirrhosis was found (p = 0.02); however, in the multivariate logistic regression analysis the concentration of D-dimer did not appear as an independent predictor of adverse outcome.
These findings are consistent with the role of increased local fibrinolysis in the digestive tract, particularly of D-dimer, in patients with upper gastrointestinal hemorrhage and adverse outcome. Accordingly, plasma fibrinolytic tests may constitute an appropriate prognostic marker in upper gastrointestinal bleeding.
From the Department of Internal Medicine (A.G., M.P-M.), Hospital General Universitario, Universidad Miguel Hernández; and the Department of Epidemiology (J.S-P.) and the Service of Hematology (P.M.), Hospital General Universitario de Alicante, Alicante, Spain.
Submitted March 6, 2000.
Accepted November 3, 2000.
Address correspondence and reprint requests to Dr. Miguel Pérez-Mateo, Department of Internal Medicine, Hospital General Universitario de Alicante, Maestro Alonso 109, E-03010 Alicante, Spain.