Evaluation of the Effects of Shock Index, Serum Lactate, and Plasma Osmolarity Levels on Morbidity and Mortality in Patients Diagnosed with Gastrointestinal System Bleeding in the Emergency Department

Abstract

Objective: Gastrointestinal system (GIS) bleeding is a frequent cause of emergency department admissions with substantial morbidity and mortality. Although validated scoring systems exist, they are complex and require endoscopic or multiple laboratory parameters. This study aimed to evaluate the prognostic significance of shock index, serum lactate, and plasma osmolarity, which are simple and rapidly obtainable parameters, in predicting mortality in patients presenting with GIS bleeding. Methods: This retrospective observational study included 311 patients admitted to the Emergency Medicine Clinic of University of Health Sciences, Bağcılar Training and Research Hospital between January 2019 and December 2021 with a diagnosis of GIS bleeding. Demographic data, clinical findings, and laboratory parameters were analyzed. Shock index, serum lactate, and plasma osmolarity were calculated for each patient. Survivors and non-survivors were compared using univariate and multivariate statistical analyses. Receiver operating characteristic (ROC) curves were generated to assess predictive performance. Results: The mean age of the study population was 61.6 ± 18.8 years, with a male predominance (70%). Overall mortality was 2.9% (n=9), significantly higher in female patients (6.5% vs. 1.4%, p=0.015). Non-survivors exhibited markedly elevated lactate (9.71 ± 1.50 mmol/L vs. 2.19 ± 1.36 mmol/L), osmolarity (327.25 ± 16.89 mOsm/L vs. 291.08 ± 8.96 mOsm/L), and shock index (1.34 ± 0.11 vs. 0.80 ± 0.19) compared to survivors (all p<0.001). ROC curve analysis revealed excellent predictive value: lactate (AUC=1.000), osmolarity (AUC=0.998), and shock index (AUC=0.985). Multivariate regression confirmed these parameters as independent predictors of mortality. Conclusion: Serum lactate, shock index, and plasma osmolarity are simple, inexpensive, and rapidly obtainable parameters that independently predict mortality in GIS bleeding. Their incorporation into initial risk assessment may improve early prognostication, guide clinical decision-making, and optimize resource allocation in emergency settings.

Keywords

• Gastrointestinal bleeding
• shock index
• serum lactate
• plasma osmolarity
• mortality
• prognosis

Acil Serviste Tanısı Konulan Gastrointestinal Sistem Kanaması Olan Hastaların Şok İndeksi, Serum Laktat ve Plazma Osmolarite Seviyesinin Morbidite ve Mortaliteye Etkisinin Değerlendirilmesi

Abstract

Amaç: Gastrointestinal sistem (GİS) kanaması, acil servise başvuruların en sık nedenlerinden biridir ve önemli morbidite ve mortalite ile ilişkilidir. Geçerliliği kanıtlanmış risk skorları mevcut olsa da bu sistemler karmaşık olup endoskopik veya çoklu laboratuvar parametreleri gerektirmektedir. Bu çalışmada, basit ve hızlı bir şekilde elde edilebilen üç parametrenin — şok indeksi, serum laktat ve plazma osmolaritesi — GİS kanamalı hastalarda mortaliteyi öngörmedeki prognostik değerinin değerlendirilmesi amaçlandı. Yöntemler: Bu retrospektif gözlemsel çalışmaya, 1 Ocak 2019 ile 1 Aralık 2021 tarihleri arasında Sağlık Bilimleri Üniversitesi Bağcılar Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği’ne GİS kanaması tanısıyla başvuran 311 hasta dahil edildi. Hastaların demografik verileri, klinik bulguları ve laboratuvar parametreleri incelendi. Her hasta için şok indeksi, serum laktat ve plazma osmolaritesi hesaplandı. Sağ kalan ve ölen hastalar tek değişkenli ve çok değişkenli istatistiksel analizlerle karşılaştırıldı. Prognostik performansı değerlendirmek için ROC eğrileri oluşturuldu. Bulgular: Çalışma grubunun ortalama yaşı 61,6 ± 18,8 yıl olup erkek cinsiyet baskındı (%70). Genel mortalite oranı %2,9 (n=9) idi ve kadınlarda anlamlı olarak daha yüksekti (%6,5’e karşı %1,4, p=0,015). Sağ kalmayan hastalarda laktat (9,71 ± 1,50 mmol/L’ye karşı 2,19 ± 1,36 mmol/L), osmolarite (327,25 ± 16,89 mOsm/L’ye karşı 291,08 ± 8,96 mOsm/L) ve şok indeksi (1,34 ± 0,11’e karşı 0,80 ± 0,19) değerleri sağ kalanlara göre anlamlı derecede yüksekti (tümünde p<0,001). ROC eğrisi analizi mükemmel prediktif değer gösterdi: laktat (AUC=1,000), osmolarite (AUC=0,998) ve şok indeksi (AUC=0,985). Çok değişkenli regresyon analizinde bu parametrelerin mortalitenin bağımsız öngördürücüleri olduğu doğrulandı. Sonuç: Serum laktat, şok indeksi ve plazma osmolaritesi; basit, ucuz ve hızlı elde edilebilen parametrelerdir ve GİS kanamasında mortaliteyi bağımsız olarak öngörmektedir. Bu parametrelerin ilk risk değerlendirmesine dahil edilmesi, erken prognostik doğruluğu artırabilir, klinik karar verme süreçlerine rehberlik edebilir ve acil servislerde kaynak kullanımını optimize edebilir.

Keywords

• Gastrointestinal kanama
• şok indeksi
• serum laktat
• plazma osmolaritesi
• mortalite
• prognoz

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