Use of the blood urea nitrogen level to predict the rebleeding in patients with non-variceal upper gastrointestinal bleeding

The blood urea nitrogen (BUN) and blood urea nitrogen-to-creatinine ratio (BCR) are elevated in patients with upper gastrointestinal bleeding (UGIB). If bleeding persists after an initial endoscopic hemostasis, BUN levels will remain elevated or continue to increase. When identifying the occurrence of rebleeding is difficult, clinicians should perform second-look endoscopy, which is costly and invasive. This study aimed to evaluate whether changes in the BCR or BUN levels aid in determining rebleeding in patients with UGIB. Two hundred eleven patients underwent an initial and follow-up endoscopy within 72 hours for non-variceal UGIB at Chungbuk National University Hospital (Cheongju, Korea). We evaluated the changes in the BCR and BUN levels, based on the presence of rebleeding within 72 hours of the initial endoscopy. Twenty-five (11.8%) patients had rebleeding at the follow-up endoscopy within 72 hours after the initial endoscopy. The overall initial BCR was 38.3 ± 16.0 (median: 35.8). The BCR difference at follow-up endoscopy was 14.1 ± 14.5 in the no-rebleeding group and 4.5 ± 13.2 in the rebleeding group (P = .004). The optimal cutoff value of the BCR difference to predict rebleeding was 8.8. The changes in the BUN level at the follow-up endoscopy were 14.4 ± 12.3 mg/dL in the no-rebleeding group and 5.4 ± 9.5 mg/dL in the rebleeding group (P = .001). The optimal cutoff value of the BUN difference that predicted rebleeding was 7.5 mg/dL. Multivariate analysis revealed that older patients tended to have more rebleeding (P = .034). BCR and BUN level changes may aid in determining whether rebleeding has occurred, thereby preventing unnecessary second-look endoscopy in patients with UGIB.