Evaluation of the Relationship Between Bleeding Severity and Platelet Mass Index in Geriatric Patients with Upper Gastrointestinal Bleeding in the Emergency Department

Year 2022, Volume: 5 Issue: 4, 175 - 180, 30.12.2022

Hüseyin Uzunosmanoğlu Emine Emektar Seda Dağar Sedanur Şafak Şeref Kerem Çorbacıoğlu Metin Uzman

https://doi.org/10.54996/anatolianjem.1079387

Abstract

Aim: Platelet mass index (PMI) is closely correlated with platelet function in various diseases. In the present study, we aimed to evaluate the use of PMI in predicting bleeding severity and mortality in geriatric patients with acute upper gastrointestinal (GI) bleeding.

Material and Methods: This study is a retrospective study. Local ethics committee approval was obtained. It enrolled patients aged 65 years or older who presented to the emergency department (ED) with upper GI bleeding. The patients’ demographic data, comorbid disorders, results of laboratory studies and endoscopic procedures, hospital outcomes, and 30-day mortality rate were evaluated. A p-value of less than 0.05 was considered statistically significant.

Results: This study included 167 patients. Among them, 40.1% were female, and their median age was 79 (IQR 25-75, 71-86) years. The median Rockall score was 4 (IQR 25-75, 2-5); and the 30-day mortality rate was 13.2 % (n=22). The most common causes of bleeding were duodenal/gastric ulcer and/or erosive gastritis. A comparison of the non-surviving and surviving patients showed that the non-survivor ones were hemodynamically more unstable, had a greater rate of heart failure, higher BUN, creatinine, and Rockall score, and lower platelet count, albumin, and PMI (p=0.026, p=0.029, p=0.048, p=0.018, p=0.013, p<0.001, p=0.025, respectively).

Conclusion: Early detection and appropriate management of high-risk elderly patients may contribute to shortening the time to stabilize these patients. Our study showed that PMI was closely associated with mortality in elderly patients who had GI bleeding. We showed that, as PMI decreased, the patients had lower survival and more severe GI bleeding.

Keywords

Geriatric, gastrointestinal bleeding, mortality, platelet mass index

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Acil Serviste Üst Gastrointestinal Kanamalı Geriatrik Hastalarda Kanama Şiddeti İle Platelet Kitle İndeks İlişkisinin Değerlendirilmesi

Abstract

Amaç: Trombosit kitle indeksi (PMI), çeşitli hastalıklarda trombosit fonksiyonu ile yakından ilişkili olduğu gösterilmiştir. Bu çalışmada akut üst gastrointestinal (Gİ) kanama geçiren geriatrik hastalarda trombosit kitle indekslerinin kanama şiddeti ve mortalite tahmininde kullanılabilirliğini araştırmayı amaçladık.

Gereç ve Yöntemler: Çalışma retrospektif, analitik bir çalışmadır. Lokal etik kurul izni alınmıştır. Acil Tıp Kliniğine başvuran üst Gİ kanama tanısı alan 65 yaş ve üzeri hastalar çalışmaya dahil edildi. Hastaların demografik verileri, komorbid hastalıkları, laboratuvar endoskopi sonuçları ve hastane sonlanımları ve bir aylık mortaliteleri değerlendirildi. Hastaların Rockall skorları hesaplandı. p<0.05 için sonuçlar istatistiksel olarak anlamlı kabul edildi.

Bulgular: Çalışmaya 167 hasta dahil edildi. Hastaların % 40.1 kadın cinsiyette olup yaş ortancası 79 (IQR 25-75, 71-86) olarak saptandı. Rockall skorları ortancası 4 (IQR25-75, 2-5) olup 30 günlük mortalite %13.2 (n=22) bulundu. Kanamaların en sık sebebi duodenal/gastrik ülser ve/veya eroziv gastrit olduğu görüldü. Yaşayan ve ölen hastalar karşılaştırıldığında ölen hastaların hemodinamik olarak daha fazla anstabil olduğu, kalp yetmezliğinin daha fazla olduğu, ayrıca BUN, kreatinin, Rockall skorları daha yüksek, trombosit, albümin, PMI daha düşük olduğu görüldü (sırasıyla p=0.026, p=0.029, p=0.048, p=0.018, p=0.013, p<0.001, p=0.025).

Sonuç: Yüksek riskli yaşlı hastaların erken tespiti ve uygun yönetimi, bu hastaların stabilizasyon süresinin kısaltılmasına katkıda bulunabilir. Çalışmamız, GI kanaması olan yaşlı hastalarda PMI'nin mortalite ile yakından ilişkili olduğunu gösterdi. PMI azaldıkça hastaların sağ kalımlarının daha düşük olduğunu ve daha şiddetli GI kanaması yaşadıklarını gösterdik.

Keywords

Geriatri, gastrointestinal kanama, mortalite, trombosit kitle indeksi

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