Clinical characteristics of hospitalized children with gastrointestinal bleeding and risk factors for associated anemia

Table 1 Baseline demographic characteristics of all patients

Variables	n	%
Age (year)
≤ 2	72	28.02
2-5	66	25.68
5-12	94	36.58
> 12	25	9.73
Sex
Male	165	64.20
Female	92	35.80
Place of residence
Urban	186	72.37
Rural	71	27.63
Use of NSAIDs
No	214	83.27
Yes	43	16.73

NSAID: Non-steroidal anti-inflammatory drug.

Table 2 Clinical presentations and confirmed diagnoses of all patients

Variables	n	%
Hematochezia
No	113	43.97
Yes	144	56.03
Vomiting
No	175	68.09
Yes	82	31.91
Hematemesis
No	195	75.88
Yes	62	24.12
Abdominal pain
No	173	67.32
Yes	84	32.68
Melena
No	223	86.77
Yes	34	13.23
Diarrhea
No	203	78.99
Yes	54	21.01
Duodenal bulb ulcer
No	239	93.00
Yes	18	7.00
Gastric ulcer
No	251	97.67
Yes	6	2.33
Crohn’s disease
No	252	98.05
Yes	5	1.95
Helicobacter pylori infection
No	231	89.88
Yes	26	10.12
Meckel’s diverticulum
No	245	95.33
Yes	12	4.67
Colitis
No	221	85.99
Yes	36	14.01
Colonic polyp
No	225	87.55
Yes	32	12.45
Acute enteritis
No	229	89.11
Yes	28	10.89
Acute gastroenteritis
No	255	99.22
Yes	2	0.78
Rectal polyp
No	236	91.83
Yes	21	8.17
Superficial gastritis
No	235	91.44
Yes	22	8.56
Anal fissure
No	250	97.28
Yes	7	2.72
Acute gastritis
No	242	94.16
Yes	15	5.84

Table 3 Age-group differences in clinical presentations, n (%)

Variables	≤ 2 years (n = 72)	2-5 years (n = 66)	5-12 years (n = 94)	> 12 years (n = 25)	χ2 value	P value
Hematochezia					9.94	0.019
No	23 (31.94)	27 (40.91)	47 (50.00)	16 (64.00)
Yes	49 (68.06)	39 (59.09)	47 (50.00)	9 (36.00)
Vomiting					2.80	0.423
No	54 (75.00)	42 (63.64)	61 (64.89)	18 (72.00)
Yes	18 (25.00)	24 (36.36)	33 (35.11)	7 (28.00)
Hematemesis					2.06	0.560
No	57 (79.17)	46 (69.70)	72 (76.60)	20 (80.00)
Yes	15 (20.83)	20 (30.30)	22 (23.40)	5 (20.00)
Abdominal pain					50.05	< 0.001
No	70 (97.22)	46 (69.70)	46 (48.94)	11 (44.00)
Yes	2 (2.78)	20 (30.30)	48 (51.06)	14 (56.00)
Melena					18.16	< 0.001
No	69 (95.83)	62 (93.94)	74 (78.72)	18 (72.00)
Yes	3 (4.17)	4 (6.06)	20 (21.28)	7 (28.00)
Diarrhea					31.01	<0.001
No	42 (58.33)	52 (78.79)	88 (93.62)	21 (84.00)
Yes	30 (41.67)	14 (21.21)	6 (6.38)	4 (16.00)

Table 4 Laboratory parameters of all patients

Variables	Median (Q1, Q3)
Hemoglobin (g/L)	116.00 (98.00, 126.00)
White blood cell count (× 109/L)	8.11 (6.28, 10.61)
Monocyte count (× 109/L)	0.50 (0.38, 0.73)
Lymphocyte count (× 109/L)	2.79 (1.84, 4.13)
Neutrophil count (× 109/L)	3.75 (2.44, 5.78)
Albumin (g/L)	42.60 (39.40, 45.80)
Serum potassium (mM)	4.17 (3.92, 4.47)
Serum sodium (mM)	138.00 (137.00, 140.00)
Blood urea nitrogen (mM)	4.00 (3.00, 5.10)
Serum creatinine (μM)	31.70 (24.40, 38.90)
C-reactive protein (mg/L)	0.80 (0.20, 5.20)
Activated partial thromboplastin time (second)	29.10 (26.90, 31.60)
Prothrombin time (second)	12.00 (11.40, 12.90)

Table 5 Demographic differences between anemic and non-anemic patients, n (%)

Variables	Non-anemic group (n = 212)	Anemic group (n = 45)	χ2 value	P value
Age, years			17.54	< 0.001
≤ 2	66 (31.13)	6 (13.33)
2-5	60 (28.30)	6 (13.33)
5-12	70 (33.02)	24 (53.33)
> 12	16 (7.55)	9 (20.00)
Sex			0.98	0.322
Male	139 (65.57)	26 (57.78)
Female	73 (34.43)	19 (42.22)
Place of residence			4.18	0.041
Urban	159 (75.00)	27 (60.00)
Rural	53 (25.00)	18 (40.00)
Use of NSAIDs			0.42	0.518
No	178 (83.96)	36 (80.00)
Yes	34 (16.04)	9 (20.00)

NSAID: Non-steroidal anti-inflammatory drug.

Table 6 Symptomatic differences between anemic and non-anemic patients, n (%)

Variables	Non-anemic group (n = 212)	Anemic group (n = 45)	χ2 value	P value
Hematochezia			5.69	0.017
No	86 (40.57)	27 (60.00)
Yes	126 (59.43)	18 (40.00)
Vomiting			1.64	0.200
No	148 (69.81)	27 (60.00)
Yes	64 (30.19)	18 (40.00)
Hematemesis			0.19	0.661
No	162 (76.42)	33 (73.33)
Yes	50 (23.58)	12 (26.67)
Abdominal pain			2.26	0.133
No	147 (69.34)	26 (57.78)
Yes	65 (30.66)	19 (42.22)
Melena			60.43	< 0.001
No	200 (94.34)	23 (51.11)
Yes	12 (5.66)	22 (48.89)
Diarrhea			9.02	0.003
No	160 (75.47)	43 (95.56)
Yes	52 (24.53)	2 (4.44)
Duodenal bulb ulcer			28.83	< 0.001
No	206 (97.17)	33 (73.33)
Yes	6 (2.83)	12 (26.67)
Gastric ulcer			7.09	0.008
No	210 (99.06)	41 (91.11)
Yes	2 (0.94)	4 (8.89)
Crohn’s disease			-	0.211
No	209 (98.58)	43 (95.56)
Yes	3 (1.42)	2 (4.44)
Helicobacter pylori infection			29.32	< 0.001
No	201 (94.81)	30 (66.67)
Yes	11 (5.19)	15 (33.33)
Meckel’s diverticulum			17.64	< 0.001
No	208 (98.11)	37 (82.22)
Yes	4 (1.89)	8 (17.78)
Colitis			4.14	0.042
No	178 (83.96)	43 (95.56)
Yes	34 (16.04)	2 (4.44)
Colonic polyp			7.76	0.005
No	180 (84.91)	45 (100.00)
Yes	32 (15.09)	0 (0.00)
Acute enteritis			5.38	0.020
No	184 (86.79)	45 (100.00)
Yes	28 (13.21)	0 (0.00)
Acute gastroenteritis			-	1.000
No	210 (99.06)	45 (100.00)
Yes	2 (0.94)	0 (0.00)
Rectal polyp			1.70	0.192
No	192 (90.57)	44 (97.78)
Yes	20 (9.43)	1 (2.22)
Superficial gastritis			0.04	0.836
No	193 (91.04)	42 (93.33)
Yes	19 (8.96)	3 (6.67)
Anal fissure			0.54	0.464
No	205 (96.70)	45 (100.00)
Yes	7 (3.30)	0 (0.00)
Acute gastritis			2.22	0.137
No	197 (92.92)	45 (100.00)
Yes	15 (7.08)	0 (0.00)

Table 7 Laboratory differences between anemic and non-anemic patients

Variables	Non-anemic group (n = 212)	Anemic group (n = 45)	Z value	P value
Hemoglobin (g/L)	119.00 (110.75, 127.25)	75.00 (64.00, 84.00)	-9.88	< 0.001
White blood cell count (× 109/L)	8.29 (6.67, 10.93)	6.39 (4.95, 9.07)	-3.52	< 0.001
Monocyte count (× 109/L)	0.53 (0.39, 0.74)	0.38 (0.27, 0.61)	-3.23	0.001
Lymphocyte count (× 109/L)	3.13 (2.01, 4.36)	2.06 (1.66, 2.64)	-3.92	< 0.001
Neutrophil count (× 109/L)	3.77 (2.45, 5.78)	3.36 (2.42, 5.09)	-0.68	0.495
Albumin (g/L)	43.20 (40.50, 46.12)	38.70 (35.30, 41.90)	-5.75	< 0.001
Serum potassium (mM)	4.21 (3.96, 4.50)	4.01 (3.81, 4.30)	-2.97	0.003
Serum sodium (mM)	138.00 (136.75, 140.00)	138.00 (137.00, 139.00)	-0.28	0.778
Blood urea nitrogen (mM)	3.90 (2.90, 5.03)	4.30 (3.30, 5.60)	-1.71	0.087
Serum creatinine (μM)	31.35 (24.30, 38.35)	35.40 (25.50, 40.60)	-1.28	0.199
C-reactive protein (mg/L)	0.80 (0.20, 5.23)	0.80 (0.30, 4.80)	-0.68	0.494
Activated partial thromboplastin time (second)	29.45 (27.48, 32.00)	27.30 (24.80, 29.00)	-3.83	< 0.001
Prothrombin time (second)	11.95 (11.38, 12.70)	12.50 (11.90, 13.30)	-3.60	< 0.001

Table 8 Univariate logistic regression for risk of anemia

Variables	β	OR (95%CI)	P value
Age (year)
≤ 2		1.00
2-5	0.10	1.10 (0.34-3.60)	0.875
5-12	1.33	3.77 (1.45-9.81)	0.006
> 12	1.82	6.19 (1.92-19.91)	0.002
Sex
Male		1.00
Female	0.33	1.39 (0.72-2.68)	0.324
Place of residence
Urban		1.00
Rural	0.69	2.00 (1.02-3.92)	0.043
Use of NSAIDs
No		1.00
Yes	0.27	1.31 (0.58-2.96)	0.519
Hematochezia
No		1.00
Yes	-0.79	0.46 (0.24-0.88)	0.019
Vomiting
No		1.00
Yes	0.43	1.54 (0.79-3.00)	0.202
Hematemesis
No		1.00
Yes	0.16	1.18 (0.57-2.45)	0.661
Abdominal pain
No		1.00
Yes	0.50	1.65 (0.85-3.20)	0.136
Melena (n)
No		1.00
Yes	2.77	15.94 (6.99-36.38)	< 0.001
Diarrhea
No		1.00
Yes	-1.94	0.14 (0.03-0.61)	0.009
White blood cell count	-0.11	0.89 (0.81-0.99)	0.029
Monocyte count	-0.51	0.60 (0.25-1.47)	0.264
Lymphocyte count	-0.50	0.61 (0.47-0.79)	< 0.001
Neutrophil count	-0.02	0.98 (0.91-1.06)	0.670
Albumin	-0.19	0.83 (0.77-0.89)	< 0.001
Serum potassium	-1.25	0.29 (0.12-0.67)	0.004
Serum sodium	-0.03	0.97 (0.86-1.09)	0.569
Blood urea nitrogen	0.20	1.22 (1.03-1.45)	0.019
Serum creatinine	0.02	1.02 (0.99-1.04)	0.235
C-reactive protein	-0.01	0.99 (0.96-1.02)	0.418
Activated partial thromboplastin time	-0.14	0.87 (0.79-0.95	0.002
Prothrombin time	0.47	1.61 (1.22-2.13)	< 0.001

NSAID: Non-steroidal anti-inflammatory drug.

Table 9 Multivariate Logistic regression for risk of anemia

Variables	β	OR (95%CI)	P value
Age (year)
≤ 2		1.00
2-5	-1.84	0.16 (0.03-0.94)	0.042
5-12	-1.65	0.19 (0.04-1.03)	0.055
> 12	-0.49	0.61 (0.10-3.86)	0.601
Place of residence
Urban		1.00
Rural	0.33	1.39 (0.50-3.86)	0.522
Hematochezia
No		1.00
Yes	1.22	3.38 (0.89-12.85)	0.074
Melena (n)
No		1.00
Yes	3.29	26.85 (6.00-120.21)	< 0.001
Diarrhea
No		1.00
Yes	-2.58	0.08 (0.01-0.45)	0.005
White blood cell count	-0.06	0.94 (0.84-1.05)	0.272
Lymphocyte count	-0.55	0.58 (0.34-0.98)	0.042
Albumin	-0.25	0.78 (0.70-0.86)	< 0.001
Serum potassium	-1.36	0.26 (0.07-1.01)	0.051
Blood urea nitrogen	0.05	1.05 (0.79-1.41)	0.724
Activated partial thromboplastin time	-0.13	0.87 (0.77-0.99)	0.031
Prothrombin time	0.23	1.26 (0.80-1.99)	0.321