High c-reactive protein level as risk factors of complications in upper gastrointestinal bleeding

I Ketut Mariadi , Karismayusa Sudjana, I Dewa Nyoman Wibawa

I Ketut Mariadi
Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia ; Doctoral program, Faculty of Medicine, Udayana University. Email: [email protected]

Karismayusa Sudjana
Internal Medicine Residency Program, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital

I Dewa Nyoman Wibawa
Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia
Online First: October 30, 2020 | Cite this Article
Mariadi, I., Sudjana, K., Wibawa, I. 2020. High c-reactive protein level as risk factors of complications in upper gastrointestinal bleeding. Bali Medical Journal 9(3): 698-701. DOI:10.15562/bmj.v9i3.2015

Purpose: Upper gastrointestinal bleeding is the major medical emergency case in the field of gastroenterology. The complications of UGI bleeding are recurrent bleeding and death. Identifying risk factors for the complications is expected to prevent or reduce recurrent bleeding complications and deaths from UGI bleeding. This study aims to know the risk of UGI bleeding complications in patients with a high level of C reactive protein (CRP).

Patients and methods: A prospective observational analytic study was performed, including all UGI bleeding patients (variceal and nonvariceal). CRP level was used to determine the high-risk cohort. High-risk cohort if the CRP level 5 mg/L and above, and low risk if CRP level less than 5 mg/L. The outcome of the study was the incidence of complication, both rebleeding and death during follow up for six weeks. 

Results: Based on the characteristic data of the sample, the high-risk group appears to have a slightly older age, higher leucocyte count, lower hemoglobin levels, and higher serum creatinine than the low-risk group. The incidence rate of complication in the high-risk group was 85.3% while in the low-risk group was 37.5%, and the relative risk (RR) was 2.27 (95% CI: 1.43-3.67). There were significant differences in the incidence of complications between the group, X2: 16; p <0.001. The RR for rebleeding in the high-risk to low-risk cohort was 2.68 (95% CI: 1.31-5.47); this difference is statistically significant (X2:9.3; p=0.02). The RR for death complication was 1.70 (95% CI: 0.63-4.53), and the difference is not statistically significant (X2: 1.2; p=0.28).

Conclusion: In this study, we found the CRP level ≥ 5 mg/L as a significant risk factor for rebleeding complications but not mortality in a patient with UGI bleeding.


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