The correlation between leukocytosis and the severity of bleeding in patients with acute non-variceal upper gastrointestinal system bleeding

Yıl 2014, Cilt: 13 Sayı: 1, 7 - 12, 01.04.2014

Mustafa Keçeci Can Sevinç Kadir Kayataş - Koray Koçhan - Arif Şahin Zeynep Ece Demirtaş - Ferhat Ferhatoğlu - Ezgi Ersoy Yeşil Refik Demirtaş -

Öz

Background and Aims:Many studies have investigated the correlation between laboratory parameters checked at presentation to the hospital and the severity of bleeding in patients with acute non-variceal upper gastrointestinal system bleeding. In this study, we investigated the predictive value of leukocytosis determined at presentation to the hospital in predicting the severity of bleeding. Materials and Methods: Patients presenting to the emergency polyclinic of Haydarpaşa Numune Training and Research Hospital between 2006 and 2010 with the complaint of hematemesis and/or melena and admitted to the Internal Medicine Clinic due to upper gastrointestinal system bleeding with the detection of melena and/or hematemesis were included in the study. Collection of demographic data, upper gastrointestinal endoscopy findings, and pathological results of biopsies taken during the endoscopy was performed retrospectively. Only leukocyte values determined at presentation to the emergency polyclinic were taken into consideration.Results: Statistically significant differences were determined between the groups regarding the number of leukocytes (p: 0,007), number of platelets (p: 0,039), blood urea nitrogen levels (p: 0,000), albumin levels (p: 0,006), requirement for erythrocyte suspension replacement (p: 0,040), and requirement for fresh frozen plasma replacement (p: 0,045). Conclusions:The close association between leukocytosis and the markers of severe bleeding, such as blood urea nitrogen, requirement for erythrocyte suspension and fresh frozen plasma and hypoalbuminemia, shows that leukocytosis can be used as a parameter to help predict the severity of the clinical course at presentation to the emergency polyclinic. The inability to determine a significant difference between the hospitalization periods can be attributed to the small numbers of patients in our study. It seems that future studies performed in large patient series will facilitate leukocytosis taking its place among the clinical scoring systems used for upper gastrointestinal system bleedings.

Anahtar Kelimeler

Leukocytosis, upper gastrointestinal system bleeding

Varis dışı akut üst gastrointestinal sistem kanamalı hastalardalökositoz ile kanama ciddiyeti arasındaki ilişki

Öz

Giriş ve Amaç: Varis dışı üst gastrointestinal sistem kanamalı hastaların, hastaneye başvuru sırasında bakılan laboratuvar parametreleri ile kanamanın ciddiyeti arasındaki ilişkiyi araştıran birçok çalışma vardır. Biz de bu çalışmamızda hastaların başvuru sırasında tespit edilen lökositozun kanama ciddiyetini gösterme açısından prediktif değerini araştırdık. Gereç ve Yöntem: Çalışmaya 2006-2010 yılları arasında hastanemiz Haydarpaşa Numune Eğitim ve Araştırma Hastanesi acil polikliniğine hematemez ve/veya melena şikayeti ile başvuran, melena ve/veya hematemezi saptanıp, üst gastrointestinal sistem kanama nedeniyle İç Hastalıkları kliniğine yatırılan hastalar alındı. Bu hastaların demografik bilgileri, üst gastrointestinal sistem endoskopi bulguları ve endoskopi sırasında alınan biyopsilerin patoloji sonuçları retrospektif olarak toplanarak kaydedildi. Hastaların yalnızca acil polikliniğe başvuru sırasındaki lökosit değerleri dikkate alındı. Bulgular:Gruplar arasında lökosit sayı-ları açısından istatistiki olarak anlamlı fark saptandı (p:0,007). Gruplar arasında platelet sayıları açısından (p:0,039), kan üre nitrojen düzeyleri açısından (p:0,000), albumin düzeyleri açısından (p:0,006), eritrosit süspansiyonu replasman ihtiyaçları açısından (p:0,040), taze donmuş plazma replasman ihtiyaçları açısından istatistiki olarak anlamlı fark saptandı (p:0,045). Sonuç: Lökositoz ile ciddi kanama göstergeleri olan kan üre nitrojeni, eritrosit süspansiyonu ve taze donmuş plazma tarnsfüzyonu ihtiyacı ve hipoalbuminemi ile yakın ilişkili olması; lökositozun başvuru sırasında klinik seyrin ciddiyetini öngörmeye yardımcı olacak bir parametre olarak kullanılabileceğini göstermekte iken hastane yatış süreleri arasında anlamlı fark tespit edilememiş olması hasta sayımızın kısıtlı olması ile ilişkilendirilebilir. Geniş hasta serilerinde yapılacak çalışmalar, lökositozun üst gastrointestinal sistem kanamalarında kullanılan klinik skorlamalarda yerini almasını sağlayabilecek gibi görünmektedir

Anahtar Kelimeler

Lökositoz, üst gastrointestinal sistem kanama

Kaynakça

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