Üst gastrointestinal kanamalı hastalarda endoskopik tedavi açısından üre/hemoglobin oranının prediktif değeri

Year 2023, , 499 - 504, 27.10.2023

Bayram Yeşil , Bünyamin Sevim

https://doi.org/10.47582/jompac.1350147

Abstract

Aims: Üst gastrointestinal kanamaları özofagus, mide ve duedonumu kapsayan geniş bir bölgede çeşitli patolojilere bağlı olarak gelişir. Klinik hastalar arasında oldukça değişkendir ve takip altında hızla kötüleşebilir hatta mortal seyredebilir. Hastanın tedavisinde medikal ajanlar, endoskopik girişimler, cerrahi gerekebilir ve yüksek miktarda kan transfüzyon ihtiyacı doğabilir. Hangi hastanın diğerlerinden daha fazla riskli ve acil olduğunu öngörmek hastaların doğru tedavi edilebilmesi için önemlidir. Üre/hemoglobin oranı hastaların endoskopi ihtiyacını öngörmede basit, hızlı uygulanabilir ve güvenilir bir gösterge olabilir.
Methods: Bu çalışma tek merkezli ve retrospektif bir çalışma olup çalışma kapsamında 361 üst gastrointestinal sistem kanaması ile tedavi edilmiş hasta araştırılmıştır. Hastaların yaş ve cinsiyet verileri, endoskopi kayıtları, kan tetkikleri çalışma kapsamında incelenmiştir. Yoğun bakım endikasyonu, endoskopik endikasyonu, kan transfüzyon endikasyonunda median UHR değerleri anlamlı olarak yüksek bulunmuştur (p<0,05).
Results: Hastaların çoğunluğu %72,3 ile erkekti. Median yaş 56 idi (15-96). Peptik ülser (70,9%) en sık, anjioektazi (6,65%) ikinci sıklıkta etiyolojik neden olarak tespit edildi. Hastaların 29,1%’inde yoğun bakım takibi, 36,01%’inde eritrosit replasmanı ve 46,81%’inde endoskopik tedavi gerekti. 13 hasta hayatını kaybetmiştir (3,6%). Median değer üre için 58, hemoglobin için 10,50 ve UHR için 5,75 olarak tespit edildi.
Conclusion:. Üst gastrointestinal sistem kanamaları değişken ve hızlı kötüleşmeye aday kliniklerdir. Hastalar ile her zaman ideal şartlar altında karşılaşılmayabilir ve kısıtlı imkanlar ile yönetilmesi gerekebilir. Bu sebeple acil tedavi ve girişimlere ihtiyaç duyabilecek hastaları diğerlerinden ayırt edebilecek erişimi kolay, hızlı ve güvenilir yardımcı tekniklere ihtiyaç vardır. Üre ve Üre/hemoglobin oranı bu şartları bünyesinde barındırmakta olup üst gastrointestinal sistem kanamaları açısından önemi araştırılmalıdır.

Keywords

: Üst gastrointestinal sistem kanaması, acil müdahale, endoskopi, üre, kan üre azotu, prognoz

The predictive value of the urea/hemoglobin ratio for endoscopic treatment in patients with upper gastrointestinal bleeding

Abstract

Abstract
Aims: Upper gastrointestinal bleeding develops due to various pathologies in a wide region, including esophagus, stomach, and duodenum. The clinical presentation is highly variable between patients and can rapidly deteriorate and even be fatal without follow-up. Medical agents, endoscopic interventions, and surgery may be required in the treatment of the patient, and a high blood transfusion may be required. Predicting which patients are more at risk and urgent than others is important for the correct treatment of patients. The urea/hemoglobin ratio can be a simple, rapidly applicable, and reliable indicator to predict the need for endoscopy.
Methods: This was a single-center retrospective study in which 361 patients treated for upper gastrointestinal bleeding were investigated. Age and gender data, endoscopy records, and blood tests of the patients were analyzed within the scope of the study. Median UHR values were significantly higher in intensive care indication, endoscopic indications, and blood transfusion indications (p<0.05).
Results: The majority of patients were male, with 72.3%. The median age was 56 years (15-96). Peptic ulcer (70.9%) was the most common etiologic cause, and angioectasia (6.65%) was the second most common etiologic cause. Intensive care follow-up was required in 29.1%, erythrocyte replacement in 36.01%, and endoscopic treatment in 46.81% of patients. 13 patients died (3.6%). The median value was 58 for urea, 10.50 for hemoglobin and 5.75 for UHR.
Conclusion: Upper gastrointestinal bleeding is a variable and rapidly deteriorating clinical entity. Patients may not always be encountered under ideal conditions and may need to be managed with limited resources. Therefore, there is a need for easy-to-access, rapid, and reliable auxiliary techniques to differentiate patients who may need urgent treatment and interventions from others. Urea and Urea/hemoglobin ratio fulfill these requirements, and their significance in terms of upper gastrointestinal bleeding should be investigated.

Keywords

: Upper gastrointestinal bleeding, emergency intervention, endoscopy, urea, blood urea nitrogen, prognosis

References

• Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factors for upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):415-428.
• Nable JV, Graham AC. Gastrointestinal bleeding. Emerg Med Clin North Am. 2016;34(2):309-325.
• Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician. 2012;85(5):469-476.
• Kiringa SK, Quinlan J, Ocama P, Mutyaba I, Kagimu M. Prevalence, short term outcome and factors associated with survival in patients suffering from upper gastrointestinal bleeding in a resource limited-setting, the case of Mulago hospital in Kampala, Uganda. Afr Health Sci. 2020;20(1):426-436.
• Nahon S, Hagège H, Latrive JP, et al. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study. Endoscopy. 2012;44(11):998-1008.
• Tomizawa M, Shinozaki F, Hasegawa R, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol. 2015;21(24):7500-7505.
• Chopra D, Rosenberg M, Moayyedi P, Narula N. Is Blood urea concentration an independent predictor of positive endoscopic findings in presumed upper gastrointestinal bleeding?. Dig Dis. 2020;38(1):77-84.
• Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding. Am J Emerg Med. 1999;17(1):70-72.
• Urashima M, Toyoda S, Nakano T, et al. BUN/Cr ratio as an index of gastrointestinal bleeding mass in children. J Pediatr Gastroenterol Nutr. 1992;15(1):89-92.
• Samuel R, Bilal M, Tayyem O, Guturu P. Evaluation and management of Non-variceal upper gastrointestinal bleeding. Dis Mon. 2018;64(7):333-343.
• Falcão D, Alves da Silva J, Pereira Guedes T, Garrido M, Novo I, Pedroto I. The current portrayal of non-variceal upper gastrointestinal bleeding in a Portuguese Tertiary Center. GE Port J Gastroenterol. 2021;28(6):392-397.
• Tomizawa M, Shinozaki F, Hasegawa R, et al. Low hemoglobin levels are associated with upper gastrointestinal bleeding. Biomed Rep. 2016;5(3):349-352.
• Hearnshaw SA, Logan RF, Palmer KR, Card TR, Travis SP, Murphy MF. Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2010;32(2):215-224.
• Sasaki Y, Abe T, Kawamura N, et al. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol. 2022;22(1):337.
• Shung DL, Au B, Taylor RA, et al. Validation of a machine learning model that outperforms clinical risk scoring systems for upper gastrointestinal bleeding. Gastroenterology. 2020;158(1):160-167.
• Marmo R, Koch M, Cipolletta L, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol. 2008;103(7):1639-1648.
• Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023;11:goad011.
• de Groot NL, van Oijen MG, Kessels K, et al. Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified? Endoscopy. 2014; 46 (01): 46-52.
• Kim JS, Kim BW, Kim DH, et al. Guidelines for nonvariceal upper gastrointestinal bleeding. Gut Liver. 2020;14(5):560-570.
• Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021; 53(03):300-332