Risk factors for clinically significant upper gastrointestinal system bleeding in children

Year 2020, , 12 - 17, 30.04.2020

Yusuf Aydemir Hasan Ulukapı Zeren Barış

https://doi.org/10.17940/endoskopi.730946

Abstract

Background and Aims: Although most of the upper gastrointestinal system bleedings are self-limited, it can be life threating in a small portion of patients. The aim of this study is to determine the risk factors predicting clinically significant upper gastrointestinal system bleeding in children.
Material and Method: Patients with upper gastrointestinal system bleeding and aged between 0-18 years old were enrolled. Age at diagnosis, gender, amount of bleeding, hemathemesis, melena, complaints, accompanying diseases, medication that is prone to bleeding, vital signs, capillary refill time and phsical examination findings were recorded. Hemogram, biochemistry, coagulation tests, endoscopic findings, erythrocyte transfusion, medical and/or endoscopic treatments applied, follow-ups in emergency or service and final diagnosis of bleeding were recorded. Patients with ≥ 8 points according to Sheffield scoring system defined as clinically significant upper gastrointestinal system bleeding and data were compared between groups.
Results
Fifty five children [29 (52.7%) girls, 26 (47.3%) boys; mean 8.4±5.4 years] were enrolled to the study. Seventeen children (26.8%) had clinically significant gastrointestinal system bleeding. We detected anemia in 22 children, high blood urea nitrogen level in 20 children, low count of erythrocyte in 14 children and hypoalbuminemia in 5 children at presentation. Patients with significantly upper gastrointestinal bleeding more commonly have symptoms of melena (%76.5 vs. %21.1, p <0.001), pallor (%52.9 vs %5.3, p <0.001), splenomegaly (%23.5 vs %2.6, p <0.001), esophageal varice (23.5% vs 2.6%, p=0.02), need for a fluid bolus (41.2% vs 5.3%, p <0.001), blood transfusion (70.6% vs 5.3% p<0.001), prolonged capillary refill time (35.3% vs 2.6%, p <0.001) and tachycardia (137.4±22.1 vs 117.5±21.3, p=0.01), and laboratory findings of lower erythrocyte (3.78×106/μL vs 4.29×106/μL, p <0.001), hemoglobin (9.8±2.2 mg/dL vs 11.7±2.1mg/dL, p=0.02) and albumin (3.94±0.47 vs 4.38±0.51, p=0.03) levels with higher blood urea nitrogen (19.2±8.4 mg/dL vs 13.3±4.8 mg/dL, p=0.01) levels. The most common final diagnosis were gastritis (20%), Mallory Weiss tears (16.4%), esophagitis (%12.2), ulcer (%12.2) and esophageal varices (%9.1).
Conclusion: It is important to know that clinical and laboratory signs of significant upper gastrointestinal system bleeding to predict patient at risk and timely intervention. Pallor and splenomegaly, low count of erythrocyte, hypoalbuminemia and high level of blood urea nitrogen were detected as findings showing significant upper gastrointestinal system bleeding, in addition to Sheffield scoring system.

Keywords

Clinically significant bleeding, risk factor, upper gastrointestinal system bleeding

Çocuklarda klinik olarak anlamlı üst gastrointestinal sistem kanama için risk faktörleri

Abstract

Giriş ve Amaç: Üst gastrointestinal sistem kanaması çocukluk çağında çoğunlukla hafif olmakla birlikte, hayatı tehdit eden ciddi kanama şeklinde de görülebilmektedir. Bu çalışmada klinik olarak anlamlı üst gastrointestinal sistem kanamasına işaret eden bulguların ve risk faktörlerinin belirlenmesi amaçlandı.
Gereç ve Yöntem: Çalışmaya üst gastrointestinal sistem kanaması tanısı alan, 0-18 yaş aralığında çocuklar alındı. Tanı anındaki yaşı, cinsiyeti, kanama miktarı, hematemez, melena varlığı, başvuru anındaki yakınmaları, eşlik eden hastalıkları, kanamaya yatkınlık yaratan ilaç kullanımı, vital bulguları, kapiller dolum zamanı ve sistemik fizik muayene bulguları kaydedildi. Laboratuvar tetkiklerinden hemogram, biyokimya, koagülasyon testleri, endoskopik işlem bulguları, eritrosit transfüzyonu sayısı, uygulanan medikal ve/veya endoskopik tedaviler, acilde ya da serviste izlemleri ve kanama açısından konulan son tanısı kaydedildi. Sheffield skorlamasına göre 8 puan ve üzeri alanlar anlamlı üst gastrointestinal sistem kanaması olanlar olarak gruplandı, veriler gruplar arasında karşılaştırıldı.
Bulgular: Elli beş çocuk [29 (%52.7) kız, 26 (%47.3) erkek; ortalama tanı yaşı 8.4±5.4 yıl] çalışmaya alındı. Başvuru anında 22 hastada anemi, 20 hastada kan üre azotu yüksekliği, 14 hastada eritrosit sayısında düşüklük, 5 hastada hipoalbüminemi vardı. Anlamlı kanaması olan 17 hastada; melena (%76.5 vs. %21.1, p <0.001), solukluk (%52.9 vs %5.3, p <0.001), splenomegali (%23.5 vs %2.6, p <0.001), özofageal varis (%23.5 vs. %2.6, p=0.02), bolus sıvı (%41.2 vs. %5.3, p <0.001) ve transfüzyon gereksinimi (%70.6 vs. %5.3, p <0.001) daha sık, kalp hızı (137.4±22.1 vs 117.5±21.3, p=0.01), kapiller dolum zamanı (%35.3 vs. %2.6, p <0.001) ve kan üre azotu (19.2±8.4 mg/dL vs 13.3±4.8 mg/dL, p=0.01) düzeyi daha yüksek, hemoglobin (9.8±2.2 mg/dL vs 11.7±2.1mg/dL, p=0.02), eritrosit sayısı (3.78×106/μL vs 4.29×106/μL, p <0.001) ve albümin (3.94±0.47 vs 4.38±0.51, p=0.03) düzeyleri ise daha düşük bulundu. En sık saptanan üst gastrointestinal sistem kanaması nedenleri gastrit (%20), Mallory Weiss (%16.4), özofajit (%12.2), ülser (%12.2) ve özofagus varisleri (%9.1) idi.
Sonuç: Üst gastrointestinal sistem kanaması olan hastanın riskini tahmin etmek ve zamanında gerekli girişimleri yapmak için anlamlı üst gastrointestinal sistem kanamasının klinik ve laboratuvar parametrelerini bilmek önemlidir. Sheffield skorlamasında yer alan kriterlerin yanında çalışmamızda, fizik incelemede solukluk ve splenomegali, laboratuvar incelemede ise eritrosit sayısında ve albüminde düşüklük ile kan üre azotu yüksekliği anlamlı üst gastrointestinal sistem kanamaya işaret eden bulgular olarak saptanmıştır.

Keywords

Klinik olarak anlamlı kanama, risk faktörü, üst gastrointestinal sistem kanaması

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