Objectives:

Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study.

Methods:

Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality.

Results:

Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody vs. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%).

Conclusions:

Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.

中文翻译：

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上消化道出血与血性VS的严重程度和结果。咖啡渣吐血

目标：

许多评论表明血性呕血比咖啡渣引起的严重呕血更为严重。在一项前瞻性研究中，我们评估了与出血症状相关的严重程度和结果。

方法：

连续出现呕血或黑便的患者被分类为血性呕吐（N = 1209），咖啡渣呕吐而无血性呕吐（N = 701）或没有呕血的黑便（N = 1069）。我们评估了就诊时的出血严重程度（脉搏，血压）和预后指标（血红蛋白，危险分层评分）以及出血发作的预后。主要结果是输血，干预或死亡的综合结果。

结果：

脉搏≥100次/分钟时血性和咖啡渣呕吐率相似（35％vs. 37％），收缩压≤100mm Hg（12％vs. 12％）和血红蛋白≤100g / l（25 vs. 27） ％）。出血性呕吐的危险分层评分较低。复合终点为34.7％，相比之下，血性呕吐和咖啡渣的呕吐率为38.2％。死亡率是6.6％，而9.3％。出血性呕吐（由于静脉曲张的发生率较高，需要内窥镜治疗）止血干预更常见（19.4％vs. 14.4％），再出血（7.8％vs. 4.5％）。呕血加黑便的结果较孤立的呕血更严重，包括血性（复合物：62.4 vs. 25.6％；止血干预：36.5 vs. 13.8％）和咖啡渣呕吐（复合物：59.1 vs. 27.1％；止血干预：26.4 vs 8.1％）。

结论：

与咖啡渣呕吐相比，血性呕吐与出现时的严重出血事件或更高的死亡率没有关系，但与止血干预和再出血的适度较高率有关。并发黑便会使呕血的结果恶化。内窥镜检查时机可能会考虑是否存在血性呕吐和黑便。