Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study
Introduction: Finding easily accessible and non-invasive methods for differentiating various sources of gastrointestinal (GI) bleeding before performing endoscopy and colonoscopy is of great interest. The present study was designed with the aim of evaluating the screening performance characteristic...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Shahid Beheshti University of Medical Sciences
2019-06-01
|
Series: | Archives of Academic Emergency Medicine |
Subjects: | |
Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/400 |
id |
doaj-03d0b95bb0f44366930692ca7ec2d2fe |
---|---|
record_format |
Article |
spelling |
doaj-03d0b95bb0f44366930692ca7ec2d2fe2020-11-25T03:56:12ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042019-06-017110.22037/aaem.v7i1.400400Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy StudySeyyed Mahdi Zia Ziabari0Siamak Rimaz1Afshin Shafaghi2Maryam Shakiba3Zahra Pourkazemi4Elnaz Karimzadeh5Melika Amoukhteh6Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.Anesthesiology Department, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.GI Cancer Screening and Prevention Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.School of Health, Guilan University of medical sciences, Rasht, Iran.Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.Poursina Clinical Research Development Unit, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Introduction: Finding easily accessible and non-invasive methods for differentiating various sources of gastrointestinal (GI) bleeding before performing endoscopy and colonoscopy is of great interest. The present study was designed with the aim of evaluating the screening performance characteristics of blood urea nitrogen (BUN) to Creatinine (Cr) ratio in this regard. Methods: The present diagnostic accuracy study was performed on patients with acute GI bleeding presenting to emergency department from 2011 to 2016, in a retrospective manner. BUN/Cr ratio was calculated for all patients and its accuracy in differentiation of upper and lower GI bleedings, confirmed via endoscopy or colonoscopy, was evaluated. Results: A total of 621 patients with the mean age of 59.49±17.94 (5 – 93) years were studied (60.5% male). Area under the receiver operating characteristic (ROC) curve of BUN/Cr ratio for predicting the source of GI bleeding was 0.63 (95% CI: 0.57 – 0.68). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of BUN/Cr ratio at 35 cut-off point were 19.63% (95%CI: 16.69 – 23.45), 90.16% (95%CI: 83.11 – 94.88), 89.09 (95%CI: 81.35 – 93.98), 21.53 (95%CI: 18.09 – 25.39), 8.16 (95%CI:4.76 – 13.98), and 3.65 (95%CI: 3.44 – 3.87), respectively. Conclusion: Considering the relatively proper specificity and positive predictive value of BUN/Cr ratio, in cases that bleeding source cannot be determined using other non-invasive methods, values higher than 35 can predict upper GI bleeding with high probability. However, due to the low sensitivity, values less than 35 are not diagnostic. https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/400Gastrointestinal hemorrhageblood urea nitrogencreatinineclinical decision-makingdecision support techniques |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Seyyed Mahdi Zia Ziabari Siamak Rimaz Afshin Shafaghi Maryam Shakiba Zahra Pourkazemi Elnaz Karimzadeh Melika Amoukhteh |
spellingShingle |
Seyyed Mahdi Zia Ziabari Siamak Rimaz Afshin Shafaghi Maryam Shakiba Zahra Pourkazemi Elnaz Karimzadeh Melika Amoukhteh Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study Archives of Academic Emergency Medicine Gastrointestinal hemorrhage blood urea nitrogen creatinine clinical decision-making decision support techniques |
author_facet |
Seyyed Mahdi Zia Ziabari Siamak Rimaz Afshin Shafaghi Maryam Shakiba Zahra Pourkazemi Elnaz Karimzadeh Melika Amoukhteh |
author_sort |
Seyyed Mahdi Zia Ziabari |
title |
Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study |
title_short |
Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study |
title_full |
Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study |
title_fullStr |
Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study |
title_full_unstemmed |
Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study |
title_sort |
blood urea nitrogen to creatinine ratio in differentiation of upper and lower gastrointestinal bleedings; a diagnostic accuracy study |
publisher |
Shahid Beheshti University of Medical Sciences |
series |
Archives of Academic Emergency Medicine |
issn |
2645-4904 |
publishDate |
2019-06-01 |
description |
Introduction: Finding easily accessible and non-invasive methods for differentiating various sources of gastrointestinal (GI) bleeding before performing endoscopy and colonoscopy is of great interest. The present study was designed with the aim of evaluating the screening performance characteristics of blood urea nitrogen (BUN) to Creatinine (Cr) ratio in this regard.
Methods: The present diagnostic accuracy study was performed on patients with acute GI bleeding presenting to emergency department from 2011 to 2016, in a retrospective manner. BUN/Cr ratio was calculated for all patients and its accuracy in differentiation of upper and lower GI bleedings, confirmed via endoscopy or colonoscopy, was evaluated.
Results: A total of 621 patients with the mean age of 59.49±17.94 (5 – 93) years were studied (60.5% male). Area under the receiver operating characteristic (ROC) curve of BUN/Cr ratio for predicting the source of GI bleeding was 0.63 (95% CI: 0.57 – 0.68). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of BUN/Cr ratio at 35 cut-off point were 19.63% (95%CI: 16.69 – 23.45), 90.16% (95%CI: 83.11 – 94.88), 89.09 (95%CI: 81.35 – 93.98), 21.53 (95%CI: 18.09 – 25.39), 8.16 (95%CI:4.76 – 13.98), and 3.65 (95%CI: 3.44 – 3.87), respectively.
Conclusion: Considering the relatively proper specificity and positive predictive value of BUN/Cr ratio, in cases that bleeding source cannot be determined using other non-invasive methods, values higher than 35 can predict upper GI bleeding with high probability. However, due to the low sensitivity, values less than 35 are not diagnostic.
|
topic |
Gastrointestinal hemorrhage blood urea nitrogen creatinine clinical decision-making decision support techniques |
url |
https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/400 |
work_keys_str_mv |
AT seyyedmahdiziaziabari bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT siamakrimaz bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT afshinshafaghi bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT maryamshakiba bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT zahrapourkazemi bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT elnazkarimzadeh bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy AT melikaamoukhteh bloodureanitrogentocreatinineratioindifferentiationofupperandlowergastrointestinalbleedingsadiagnosticaccuracystudy |
_version_ |
1724466460381675520 |