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Üst gastrointestinal sistem kanaması ile başvuran hastalarda başvuru laktat düzeyi ve nötrofil-lenfosit oranının mortalite ile ilişkisi

Yıl 2023, Cilt: 22 Sayı: 2, 119 - 126, 31.08.2023
https://doi.org/10.17941/agd.1348928

Öz

Giriş ve Amaç: Akut üst gastrointestinal sistem kanaması ile başvuran hastalarda, başvuru anında hastalık ciddiyetini belirlemek ve uygun müdahalelerde bulunmak prognoz açısından oldukça önemlidir. Bu sebeple birçok prognostik skorlama sistemi geliştirilmiştir. Bu çalışmadaki amacımız klinik kullanımı oldukça kolay olan başvuru laktat düzeyinin hastane içi mortaliteyi öngörme yeteneğini değerlendirmek ve mortalite ile ilişkili diğer parametreleri araştırmaktır. Gereç ve Yöntem: Çalışma Mart 2020 - Mart 2023 arasında üst gastrointestinal sistem kanaması ile başvuran 154 hasta dahil edilerek retrospektif olarak gerçekleştirilmiştir. Hastaların klinik, demografik ve laboratuvar bulguları değerlendirilerek hastane içi ölüm için bağımsız prediktörler belirlendi ve bu prediktörlerin tahmin yetenekleri incelendi. Bulgular: Toplam 154 hastanın 99'u (%64.3) erkek, 55'i (%35.7) kadındı. Çalışma popülasyonunun ortalama yaşı 67.2 ± 17.8 idi. Hastane içi mortalite 19 (%12.3) hastada gelişti. Başvurudaki nötrofil-lenfosit oranı (OR: 1.149, %95 GA:1.077 - 1.226), albümin (OR: 0.089, %95 GA: 0.021 - 0.367) ve laktat (OR: 1.202, %95 GA: 1.031 - 1.402) çok değişkenli regresyon analizinde hastane içi ölüm için bağımsız prediktörler olarak saptandı. ROC analizinde nötrofil-lenfosit oranı, albümin ve laktat kombinasyonunun hastane içi ölüm için eğri altındaki alan değeri 0.974 (%95 GA: 0.950 - 0.998) olarak bulundu. Sonuç: Başvuru laktat, nötrofil-lenfosit oranı ve albümin düzeyi hastane içi mortaliteyi predikte eden bağımsız risk faktörleri olarak bulundu.

Kaynakça

  • 1. 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;53:300-32.
  • 2. Barkun AN, Almadi M, Kuipers EJ, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med 2019;171:805-22.
  • 3. Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: Who, when and why? World J Gastrointest Pathophysiol 2016;7:86-96.
  • 4. Mujtaba S, Chawla S, Massaad JF. Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med 2020;9:402.
  • 5. Payton E, Khubchandani J, Thompson A, Price JH. Parents' Expectations of High Schools in Firearm Violence Prevention. J Community Health 2017;42:1118-26.
  • 6. Ko BS, Kim WY, Ryoo SM, et al. Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing. Crit Care Med 2015;43:2409-15.
  • 7. El-Kersh K, Chaddha U, Sinha RS, et al. Predictive Role of Admission Lactate Level in Critically Ill Patients with Acute Upper Gastrointestinal Bleeding. J Emerg Med 2015;49:318-25.
  • 8. Stokbro LA, Schaffalitzky de Muckadell OB, Laursen SB. Arterial lactate does not predict outcome better than existing risk scores in upper gastrointestinal bleeding. Scand J Gastroenterol 2018;53:586-91.
  • 9. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet 2000;356:1318-21.
  • 10. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316-21.
  • 11. Saltzman JR, Tabak YP, Hyett BH, et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011;74:1215-24.
  • 12. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;2:394-7.
  • 13. Rivers E, Nguyen B, Havstad S, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  • 14. Shah A, Chisolm-Straker M, Alexander A, et al. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. Am J Emerg Med 2014;32:752-5.
  • 15. Wada T, Hagiwara A, Uemura T, Yahagi N, Kimura A. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med 2016;11:737-43
  • 16. Lanas A, Chan FK. Peptic ulcer disease. Lancet 2017;390:613-24.
  • 17. Wang F, Meng W, Wang B, Qiao L. Helicobacter pylori-induced gastric inflammation and gastric cancer. Cancer Lett 2014;345:196-202.
  • 18. Bjarnason I, Scarpignato C, Holmgren E, et al. Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs. Gastroenterology 2018;154:500-14.
  • 19. Hotchkiss RS, Swanson PE, Freeman BD, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27:1230-51.
  • 20. Altinbilek E, Ozturk D, Kavalci C. Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleeding patients. Signa Vitae 2019;15:59-64.
  • 21. Kandemir A, Süle M, Yavaşoğlu İ, et al. Assessment of the Relationship Between Leukocyte Count and Neutrophil-to-Lymphocyte Ratio and Clinical Course in Non-Variceal Upper Gastrointestinal System Bleeding. Sakarya Tıp Dergisi 2018;8:320-6.
  • 22. Dertli R, Toka B, Asıl M, et al. Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding? Ulus Travma Acil Cerrahi Derg 2022;28:626-33.

Association between admission lactate level and neutrophil-lymphocyte ratio with mortality in patients presenting with upper gastrointestinal bleeding

Yıl 2023, Cilt: 22 Sayı: 2, 119 - 126, 31.08.2023
https://doi.org/10.17941/agd.1348928

Öz

Background and Aims: In patients presenting with acute upper gastrointestinal bleeding, determining the severity of the disease at the time of admission and making appropriate interventions is very important in terms of prognosis. For this reason, many prognostic scoring systems have been developed. Our aim in this study is to evaluate the ability of admission lactate level to predict in-hospital mortality and to investigate other mortality-related factors. Materials and Methods: The study was conducted retrospectively, including 154 patients admitted with upper gastrointestinal bleeding between March 2020 and March 2023. By evaluating the clinical, demographic and laboratory findings of the patients, independent predictors of in-hospital death were determined and the predictive abilities of these predictors were examined. Results: Of the 154 patients, 99 (64.3%) were male and 55 (35.7%) were female. The mean age of the study population was 67.2 ± 17.8 years. In-hospital mortality occurred in 19 (12.3%) patients. The neutrophil to lymphocyte ratio (OR: 1.149, %95 CI: 1.077 - 1.226), albumin (OR: 0.089, %95 CI: 0.021 - 0.367), and lactate OR: 1.202, %95 CI: 1.031 - 1.402) at admission were determined as independent predictors for in-hospital death. In ROC analysis, the area under the curve for in-hospital death for the combination of albumin, neutrophil-lymphocyte ratio and lactate was 0.974 (%95 CI: 0.950 - 0.998). Conclusion: Admission lactate, neutrophil-lymphocyte ratio and albumin levels were found to be independent risk factors predicting in-hospital mortality.

Kaynakça

  • 1. 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;53:300-32.
  • 2. Barkun AN, Almadi M, Kuipers EJ, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med 2019;171:805-22.
  • 3. Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: Who, when and why? World J Gastrointest Pathophysiol 2016;7:86-96.
  • 4. Mujtaba S, Chawla S, Massaad JF. Diagnosis and management of non-variceal gastrointestinal hemorrhage: a review of current guidelines and future perspectives. J Clin Med 2020;9:402.
  • 5. Payton E, Khubchandani J, Thompson A, Price JH. Parents' Expectations of High Schools in Firearm Violence Prevention. J Community Health 2017;42:1118-26.
  • 6. Ko BS, Kim WY, Ryoo SM, et al. Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing. Crit Care Med 2015;43:2409-15.
  • 7. El-Kersh K, Chaddha U, Sinha RS, et al. Predictive Role of Admission Lactate Level in Critically Ill Patients with Acute Upper Gastrointestinal Bleeding. J Emerg Med 2015;49:318-25.
  • 8. Stokbro LA, Schaffalitzky de Muckadell OB, Laursen SB. Arterial lactate does not predict outcome better than existing risk scores in upper gastrointestinal bleeding. Scand J Gastroenterol 2018;53:586-91.
  • 9. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet 2000;356:1318-21.
  • 10. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316-21.
  • 11. Saltzman JR, Tabak YP, Hyett BH, et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011;74:1215-24.
  • 12. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;2:394-7.
  • 13. Rivers E, Nguyen B, Havstad S, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  • 14. Shah A, Chisolm-Straker M, Alexander A, et al. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. Am J Emerg Med 2014;32:752-5.
  • 15. Wada T, Hagiwara A, Uemura T, Yahagi N, Kimura A. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med 2016;11:737-43
  • 16. Lanas A, Chan FK. Peptic ulcer disease. Lancet 2017;390:613-24.
  • 17. Wang F, Meng W, Wang B, Qiao L. Helicobacter pylori-induced gastric inflammation and gastric cancer. Cancer Lett 2014;345:196-202.
  • 18. Bjarnason I, Scarpignato C, Holmgren E, et al. Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs. Gastroenterology 2018;154:500-14.
  • 19. Hotchkiss RS, Swanson PE, Freeman BD, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27:1230-51.
  • 20. Altinbilek E, Ozturk D, Kavalci C. Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleeding patients. Signa Vitae 2019;15:59-64.
  • 21. Kandemir A, Süle M, Yavaşoğlu İ, et al. Assessment of the Relationship Between Leukocyte Count and Neutrophil-to-Lymphocyte Ratio and Clinical Course in Non-Variceal Upper Gastrointestinal System Bleeding. Sakarya Tıp Dergisi 2018;8:320-6.
  • 22. Dertli R, Toka B, Asıl M, et al. Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding? Ulus Travma Acil Cerrahi Derg 2022;28:626-33.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Gastroenteroloji ve Hepatoloji
Bölüm Makaleler
Yazarlar

Mustafa Çomoğlu Bu kişi benim 0000-0003-4977-9919

Fatih Acehan Bu kişi benim 0000-0001-8469-0907

Yayımlanma Tarihi 31 Ağustos 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 22 Sayı: 2

Kaynak Göster

APA Çomoğlu, M., & Acehan, F. (2023). Üst gastrointestinal sistem kanaması ile başvuran hastalarda başvuru laktat düzeyi ve nötrofil-lenfosit oranının mortalite ile ilişkisi. Akademik Gastroenteroloji Dergisi, 22(2), 119-126. https://doi.org/10.17941/agd.1348928

test-5