Prognostic Significance of the Hemoglobin-Albumin Ratio in Upper Gastrointestinal Bleeding

Year 2024, Volume: 11 Issue: 3, 415 - 420, 30.09.2024

Elif Tuğba Tuncel , Funda Seher Özalp Ateş

https://doi.org/10.34087/cbusbed.1476947

Abstract

Öz
Amaç
Üst gastrointestinal sistem kanaması ciddi ve hayatı tehdit eden bir hastalık olup takip ve prognoz önemlidir. Bu çalışmada HAR (Hemoglobin-Albumin Oranı) skoru ile endoskopik risk skorlama sistemlerinin prognostik değeri karşılaştırıldı.
Metod
2022-2024 yılları arasında kliniğimizde üst gastrointestinal sistem kanamasıyla izlenen 153 hastanın dosyaları geriye dönük incelendi. Endoskopik risk skorlama sistemleri (Rockall skoru (RS), Glasgow-Blatchford skoru (GBS), Forrest sınıflaması hesaplandı. Kan parametrelerinden oluşan Hemoglobin-albumin oranı (HAR) skoru hesaplandı. HAR skoru, klinik bulgular ve endoskopik skorlar Mann-Whitney U Testi ve Kruskall-Wallis Testi ile karşılaştırıldı. HAR değerleri ile sayısal değişkenler arasındaki ilişkiler Spearman Korelasyon Katsayısı ile incelendi.
Bulgular
Hastaların 122’si (%79.7) erkek, 31’i (%20,3) kadındı. Endoskopik olarak en fazla duodenal ülser (% 43,7) saptandı. Ortalama GBS 10,69±3,89, RS 4,37±2,27, HAR skoru 2,88±0,64 olarak hesaplandı. HAR skoru ile Glasgow Blatchford skoru arasında düşük düzeyde anlamlı bir ilişki vardı (r= -0,254, p=0,002). Düşük hemoglobin değeri, düşük HAR skoru ve yüksek GBS’nun kötü prognozla ilişkili olduğu saptandı.
Sonuç
Üst gastrointestinal sistem kanamalı hastalarda düşük HAR skoru kötü prognozla ilişkilidir. HAR skoru endoskopik skorlama sistemlerine benzer etkili ve güvenilir belirteçlerdir. Endoskopik skorlardan yüksek GBS ile düşük HAR skorunun ilişkili olduğu saptandı. HAR skoru basit, hızlı, pratik ve daha kolay hesaplanabilir olduğundan dolayı rutin pratikte kullanılabilecektir.

Keywords

Gastrointestinal sistem kanama, endoskopik skorlama sistemi, HAR, prognoz

Ethical Statement

Tüm veriler Helsinki Deklarasyonuna uygun elde edildi. Çalışmaya alınan hastalardan endoskopik işlem öncesi bilgilendirilmiş onamları alınmıştı. Celal Bayar Üniversitesi Tıp Fakültesi Sağlık Bilimleri Etik Kurulu kararı tarih: 13/03/2024 No:2286 kararı ile etik onayı alındı

Prognostic Significance of the Hemoglobin-Albumin Ratio in Upper Gastrointestinal Bleeding

Abstract

ABSTRACT
Objective
Upper gastrointestinal bleeding is a serious and life-threatening condition where monitoring and prognosis are crucial. This study aimed to compare the prognostic value of the hemoglobin-albumin ratio (HAR) with endoscopic risk scoring systems.
Methods
The medical records of 153 patients with upper gastrointestinal bleeding treated at our clinic between 2022 and 2024 were retrospectively reviewed. Endoscopic risk scoring systems, including the Rockall score (RS), Glasgow-Blatchford score (GBS), and Forrest classification, were calculated. The HAR score, consisting of hematologic parameters, was computed. The HAR score was compared with clinical findings and endoscopic scores using the Mann-Whitney U and Kruskal-Wallis tests. The relationships between the HAR values and numerical variables were examined using Spearman’s correlation coefficient.
Results
Of the patients, 122 (79.7%) were male and 31 (20.3%) were female. A duodenal ulcer was the most common endoscopic finding (43.7%). The mean GBS was 10.69±3.89, RS was 4.37±2.27, and HAR was 2.88±0.64. There was a low-level significant correlation between the HAR score and the Glasgow Blatchford score (r=-0.254, p=0.002). Low hemoglobin levels, a low HAR score, and a high GBS were associated with a poor prognosis.
Conclusion
In patients with upper gastrointestinal bleeding, a low HAR score is associated with a poor prognosis. The HAR score is an effective and reliable marker, similar to endoscopic scoring systems. This study revealed a correlation between a high GBS and a low HAR score. Due to its simplicity, rapid and easy calculation, and practicality, the HAR score can be used routinely in clinical practice.

Keywords

Gastrointestinal bleeding, endoscopic scoring system, HAR, prognosis

References

• 1- Barkun AN, Bardou M, Kuipers EJ et al. International Consensus Upper Gastrointestinal Bleeding Conference G. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13. doi.org/10.7326/0003-4819-152-2-201001190-000
• 2- Bryant RV, Kuo P, Williamson K at al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78(4):576–83. doi.org/10.1016/j.gie.2013.05.003
• 3- Stanley AJ, Laine L, Dalton HR et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. doi.org/10.1136/bmj.i6432
• 4- Oh SE, Choi MG, Seo JM et al. Prognostic significance of perioperative nutritional parameters in patients with gastric cancer. Clin Nutr 2019; 38: 870-876. DOI: 10.1016/j.clnu.2018.02.015
• 5- Liu X, Sun X, Liu J et al. Preoperative C-Reactive Protein/Albumin Ratio Predicts Prognosis of Patients after Curative Resection for Gastric Cancer. Transl Oncol 2015; 8: 339-345. DOI: 10.1016/j.tranon.2015.06.006
• 6- Crumley AB, Stuart RC, Mc Kernan M et al. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg 2010; 34: 2393-2398. DOI: 10.1007/s00268-010-0641-y
• 7- Huang XZ, Yang YC, Chen Y et al. Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis. Dis Markers 2019; 2019: 7606128. DOI: 10.1155/2019/7606128
• 8- Imperiale TF, Dominitz JA, Provenzale DT et al. Predicting poor outcome from acute upper gastrointestinal hemorrhage. Arch Intern Med. 2007;167:1291–1296. doi:10.1001/archinte.167.12.1291.
• 9- 9- Guglielmi A, Ruzzenente A, Sandri M et al. Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy. 2002;34:778–786. doi:10.1055/s-2002-34261.
• 10- .A. Rockall, R.F. Logan, H.B. Devlin, T.C. Northfield Risk assessment after acute upper gastrointestinal haemorrhage Gut, 38 (1996), pp. 316-321
• 11- Blatchford, W.R. Murray, M. Blatchford A risk score to predict need for treatment for upper-gastrointestinal haemorrhage Lancet, 356 (2000), pp. 1318-1321
• 12- Lau JYW, Yu Y, Tang RSY et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382:14; 1299–1308. DOI: 10.1056/NEJMoa1912484
• 13- Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol. 2019;42-43:101613. doi.org/10.1016/j.bpg.2019.04.006
• 14- Zaragoza MA, Tenias BJM, Llorente MMJ. Pre-endoscopic prognostic factor in non-varicose upper gastrointestinal bleeding: Development of a predictive algorithm. Rev Esp Enferm Dig 2002;94:139-48. PMID: 12185878
• 15- Kayataş K, Berber E, Uluköylü M, Demirtunç R. Varis Dışı akut üst gastrointestinal sistem kanamalarında Rockall skorlaması ve skorlamanın prognozla olan ilişkisi. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2013;53:107-13.
• 16- Gado AS, Ebeid BA, Abdelmohsen AM et al. Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt. Saudi J Gastroenterol. 2012;18:1;34-9. DOI: 10.4103/1319-3767.91737
• 17- Kim BJ, Moon Kyung Park MK, Sang-Jung Kim, Eun Ran Kim, Byung-Hoon Min , Hee Jung Son, Poong-Lyul Rhee, Jae J. Kim, Jong Chul Rhee , Jun Haeng Lee Comparison of Scoring Systems for the Prediction of Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Prospective Study, Dig Dis Sci (2009) 54:2523–2529. DOI 10.1007/s10620-008-0654-7
• 18- Gökçek K, Ersel M, Altuncı YA et al. Retrospective Analyses of the Utility of Glasgow-Blatchford and Rockall and Pre-Rockall Scoring Systems in Patients Admitted to the Emergency Department with Upper Gastrointestinal System Bleeding. Forbes J Med 2022;3(3):314-320. DOI: 10.4274/forbes.galenos.2022.36450.
• 19- Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M et al. Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J. 2016;4:371-9. doi.org/10.1177/2050640615604
• 20- Dicu D, Pop F, Ionescu D, Dicu T. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med. 2013;31:94-9. doi.org/10.1016/j.ajem.2012.06.009
• 21- Stanley AJ, Dalton HR, Blatchford O et al. Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2011;34:470-5. doi.org/10.1111/j.1365-2036.2011.04747.x
• 22- Robertson M, Majumdar A, Boyapati R et all. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016;83(6):1151–60. doi.org/10.1016/j.gie.2015.10.021
• 23- Kalkan C, Soykan I, Karakaya F et al. Comparison of three scoring systems for risk stratification in elderly patients with acute upper gastrointestinal bleeding. Geriatr Gerontol Int. 2017;17(4):575–83. doi.org/10.1111/ggi.12757
• 24- Hwang JH, Fisher DA, Ben-Menachem T et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012;75:1132–8. doi.org/10.1016/j.gie.2012.02.033
• 25- P. V. Akhila Arya, N. K. Thulaseedharan-Rishi Raj, Dileep C. Unnikrishnan, Aasems Jacob AIMS65, Glasgow‑Blatchford bleeding score and modified Glasgow‑Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: An accuracy and calibration study, Indian Journal of Gastroenterology, 2023;42(4):496–504. doi.org/10.1007/s12664-023-01387-z
• 26- Chen IC, Hung MS, Chiu TF et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007;25:774-9. doi.org/10.1016/j.ajem.2006.12.024
• 27- Ce-Gui Hu, Bai-E Hu, Jin-Feng Zhu et al. Prognostic significance of the preoperative hemoglobin to albümin ratio for the short-term survival of gastric cancer patients World J Gastrointest Surg 2022 June 27; 14(6): 580-593 DOI: 10.4240/wjgs.v14.i6.580