Akut Üst Gastrointestinal Kanama İle Başvuran Hastaların Endoskopi Yapılma Zamanının Hastaların Mortalitesine Etkileri

Year 2023, , 959 - 965, 30.09.2023

Guner Yurtsever

https://doi.org/10.16899/jcm.1341380

Abstract

Amaç: Endoskopi akut üst gastrointestinal kanamada (AUGIB) kanama kaynağını tespit etmek ve kanamayı durdurmak için önerilir. Endoskopinin AUGIB'de optimal zamanlaması tartışmalıdır. Çalışmamızda endoskopi zamanını ve etkileyen faktörleri araştırmayı amaçladık.
Yöntem: Çalışma retrospektif, tek merkezlidir. Hastalar taburculuk sonrası endoskopi, 0-12 saat endoskopi, 12-24 saat endoskopi ve 24 saat sonra endoskopi olmak üzere 4 gruba ayrıldı. Yaş, cinsiyet, vital bulgular, laboratuvar bulguları kaydedildi. Glasgow-Blatchford Skoru (GBS) ve Charlson komorbidite indeksi (CCI) hesaplandı. Elde edilen veriler bu dört grup arasında karşılaştırıldı. 30 gün boyunca tüm nedenlere bağlı ölümler kaydedildi.
Bulgular: Toplam 318 hasta dahil edildi. Endoskopi sürelerinin karşılaştırılmasında dört grup arasında istatistiksel olarak anlamlı bulunan parametreler Hb, BUN ve INR seviyeleri, GBS ve CCI’dır. CHAID analizi sonucunda endoskopi zamanını etkileyen en önemli değişkenin hastaların Hb değeri olduğu bulundu (χ2=66,528; düzeltilmiş p=0,000). Mortalite hastaların %10.69'unda meydana geldi. Endoskopinin zamanlaması mortaliteyi etkilemedi. Binary lojistik regresyon analizinde düşük sistolik KB (0,967 kat artış), yüksek CCI (86.402 kat artış) mortaliteyi etkilediği bulundu.
Sonuç: Endoskopinin zamanlamasını etkileyen faktörler kanama belirtileridir. Akut gastrointestinal kanama ile acil servise başvuran hastalarda hayati bulguların tam olarak izlenmesi, özellikle sistolik kan basıncının değerlendirilmesi ve ek komorbid durumların ayrıntılı olarak sorgulanması, mortaliteyi azaltmak için kritik öneme sahiptir.

Keywords

endoskopi zamanlaması, acil durum, üst gastrointestinal kanama, akut gastrointestinal kanama

Thanks

Çalışmaya katkılarından dolayı Demokrasi Üniversitesi Acil Tıp AD Başkanı Doç Dr Rezan Karaali'ye teşekkür ederim.

Evaluation of endoscopy timing in patients with acute upper gastrointestinal bleeding in emergency department

Abstract

Background: Endoscopy is recommended in acute upper gastrointestinal bleeding (AUGIB) to detect the bleeding source and stop the bleeding. The optimal timing of endoscopy in AUGIB is controversial. We aimed to investigate the time of endoscopy and the factors affecting it.
Materials and methods: Retrospective, single-center study. The patients were divided into four groups: endoscopy after discharge, 0-12 hours endoscopy, 12-24 hours endoscopy and 24 hours later. Age, sex, vital signs, laboratory findings were recorded. Glasgow-Blatchford Score (GBS) and Charlson comorbidity index (CCI) were calculated. The obtained data were compared between these four groups. All-cause mortality for 30 days was recorded.
Results: A total of 318 patients were included. In the comparison of endoscopy times, the parameters found to be statistically significant between the four groups are Hb, BUN, and INR levels, GBS and CCI. As a result of CHAID analysis, the most crucial variable affecting the timing of endoscopy was found to be the Hb value of the patients (χ2=66.528; adjusted p=0.000). Mortality occurred in 10.69% of the patients. The timing of endoscopy did not affect mortality. In binary logistic regression analysis, low systolic BP (0.967 times increase), high CCI (86,402 times increase) were found to affect mortality.
Conclusion: The factors affecting the timing of endoscopy are the signs of bleeding. A thorough follow-up of vital signs in patients presenting to the emergency department with acute gastrointestinal bleeding, particularly an evaluation of systolic blood pressure and detailed questioning of additional comorbid conditions, is critical to reduce mortality.

Keywords

endoscopy timing, emergency, upper gastrointestinal bleeding, acute gastrointestinal bleeding

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