Investigation of the Relationship Between Blood Pressure Index and Prognosis in Gastrointestinal Bleeding

Öz

Gastrointestinal bleeding is a significant cause of hospital admissions, with upper gastrointestinal bleeding (UGIB) in particular being associated with high mortality rates. This study aimed to evaluate the prognostic value and impact on mortality of a new easily calculable parameter in the emergency department: the Blood Pressure Index (BPI). This retrospective, single-centre study, it included patients over 18 years of age who presented to a tertiary care emergency department between September 1, 2023, and September 1, 2024, with symptoms such as hematemesis, melena, syncope, or haematochezia and underwent endoscopy. The following were recorded: sociodemographic characteristics, vital signs, laboratory parameters, endoscopic findings, Glasgow-Blatchford score, BPI, transfusion needs, hospitalization status, and 30-day mortality outcomes. At the end of 30 days, 92.2% (n=163) of the patients survived, while 7.8% (n=19) had died. No statistically significant relationship was found between BPI and mortality (p=0.793). However, the Glasgow-Blatchford score and its parameters, including hemoglobin, urea, and albumin levels, showed significant differences between the survivor and non-survivor groups (p<0.001). There remains a need for simple and rapid parameters to predict mortality in UGIB. Our findings suggest that BPI is not suitable for this purpose, whereas the Glasgow-Blatchford Score continues to be reliable.

Anahtar Kelimeler

• upper gastrointestinal bleeding
• blood pressure index
• clinical prognosis
• mortality

Destekleyen Kurum

None

Proje Numarası

None

Etik Beyan

Ethics approval: AEŞH-BADEK-2024-925 (Ethics Committee of Ankara Etlik City Hospital, Ankara, TURKEY

Teşekkür

None

Gastrointestinal Sistem Kanamasında Kan Basıncı İndeksi ile Prognoz Arasındaki İlişkinin İncelenmesi

Öz

Gastrointestinal kanama, hastane yatışlarının önemli nedenlerinden biri olup, özellikle üst gastrointestinal kanama (UGIB) yüksek mortalite oranlarıyla ilişkilidir. Bu çalışmada, acil serviste kolayca hesaplanabilen yeni bir parametre olan Kan Basıncı İndeksi’nin (BPI), UGIB’de prognoz tahmini ve mortalite üzerindeki etkisinin değerlendirilmesi amaçlanmıştır. Retrospektif ve tek merkezli olarak yürütülen bu çalışmaya, 1 Eylül 2023 - 1 Eylül 2024 tarihleri arasında bir üçüncü basamak eğitim ve araştırma hastanesinin acil servisine hematemez, melena, senkop veya hematokezya şikayetleriyle başvuran ve endoskopi yapılan 18 yaş üstü hastalar dahil edilmiştir. Hastaların sosyodemografik özellikleri, vital parametreleri, laboratuvar değerleri, endoskopik bulguları, Glasgow-Blatchford Skoru, BPI, kan transfüzyon ihtiyacı, yatış durumları ve 30 günlük mortalite sonuçları kaydedilmiştir. Hastaların %92,2’si (n=163) 30 gün sonunda hayatta kalırken, %7,8’i (n=19) yaşamını yitirmiştir. Mortal olan ve olmayan gruplar arasında BPI açısından istatistiksel olarak anlamlı bir fark tespit edilmemiştir (p=0,793). Ancak Glasgow-Blatchford Skoru ve onun parametrelerinden olan hemoglobin, üre ve albümin değerleri açısından gruplar arasında anlamlı farklar bulunmuştur (p<0,001). UGIB’de mortaliteyi belirlemek için basit ve hızlı parametrelere duyulan ihtiyaç devam etmektedir. Çalışmamız, BPI’nin bu amaçla uygun olmadığını Glasgow-Blatchford Skorunun ise güvenilirliğini koruduğunu göstermiştir.

Anahtar Kelimeler

• üst gastrointeninal kanama
• kan basıncı indeksi
• klinik prognoz
• mortalite

Proje Numarası

None

Kaynakça

1. Ates, H., Ates, I., Kundi, H., Arikan, M. F., & Yilmaz, F. M. (2017). A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index. The American Journal of Emergency Medicine, 35(10), 1400–1403. https://doi.org/10.1016/j.ajem.2017.04.019
2. Awadie, H., Zoabi, A., & Gralnek, I. M. (2022). Obscure-overt gastrointestinal bleeding: A review. Polish Archives of Internal Medicine, 132(5), 16253. https://doi.org/10.20452/pamw.16253
3. Blatchford, O., Murray, W. R., & Blatchford, M. (2000). A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet, 356(9238), 1318–1321. https://doi.org/10.1016/S0140-6736(00)02816-6
4. Chen, I. C., Hung, M. S., Chiu, T. F., Chen, J. C., & Hsiao, C. T. (2007). Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. The American Journal of Emergency Medicine, 25(7), 774–779. https://doi.org/10.1016/j.ajem.2006.12.024
5. Gutierrez, G., Reines, H. D., & Wulf-Gutierrez, M. E. (2004). Clinical review: Hemorrhagic shock. Critical Care, 8(5), 373–381. https://doi.org/10.1186/cc2851
6. Işık, B., Sarcan, E., & Usul, E. (2023). Relationship between blood pressure index and right ventricular dysfunction and mortality in patients with pulmonary embolism. The Journal of Kırıkkale University Faculty of Medicine, 25(2), 279–284. https://doi.org/10.24938/kutfd.1313498
7. Jung, K., & Moon, W. (2019). Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review. World Journal of Gastrointestinal Endoscopy, 11(2), 68–83. https://doi.org/10.4253/wjge.v11.i2.68
8. Karki, B., Sherpa, T. W., Aryal, E., Adhikari, A., Upadhaya Regmi, B., Katwal, S. … Dawadi, P. (2022). Upper gastrointestinal bleeding among patients admitted in department of emergency in a tertiary care centre: A descriptive cross-sectional study. JNMA: Journal of the Nepal Medical Association, 60(248), 360–363. https://doi.org/10.31729/jnma.7409

9. Kudu, E., & Danış, F. (2022). The evolution of gastrointestinal bleeding: A holistic investigation of global outputs with bibliometric analysis. The Turkish Journal of Gastroenterology, 33(12), 1012–1024. https://doi.org/10.5152/tjg.2022.22007
10. Li, Y., Lu, Q., Song, M., Wu, K., & Ou, X. (2023). Novel risk score for acute upper gastrointestinal bleeding in elderly patients: A single-centre retrospective study. BMJ Open, 13(6), e072602. https://doi.org/10.1136/bmjopen-2023-072602
11. Matthews, J. C., & McLaughlin, V. (2008). Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: A detailed review of the pathophysiology, diagnosis, and management. Current Cardiology Reviews, 4(1), 49–59. https://doi.org/10.2174/157340308783565384
12. Olivarec-Bonilla, M., García-Montano, A. M., & Herrera-Arellano, A. (2020). Upper gastrointestinal hemorrhage re-bleeding risk according to the Glasgow-Blatchford scale: A triage tool. Gaceta Medica de Mexico, 156(6), 493–498. https://doi.org/10.24875/GMM.M21000495
13. Orpen-Palmer, J., & Stanley, A. J. (2023). A review of risk scores within upper gastrointestinal bleeding. Journal of Clinical Medicine, 12(11), 3678. https://doi.org/10.3390/jcm12113678
14. Post, E. H., & Vincent, J. L. (2018). Renal autoregulation and blood pressure management in circulatory shock. Critical Care, 22(1), 81. https://doi.org/10.1186/s13054-018-1962-8
15. Saleem, S., & Thomas, A. L. (2018). Management of upper gastrointestinal bleeding by an internist. Cureus, 10(6), e2878. https://doi.org/10.7759/cureus.2878
16. Wasserman, R. D., Abel, W., Monkemuller, K., Yeaton, P., Kesar, V., & Kesar, V. (2024). Non-variceal upper gastrointestinal bleeding and its endoscopic management. The Turkish Journal of Gastroenterology, 35(8), 599–608. https://doi.org/10.5152/tjg.2024.23507
17. Yen, H. H., Wu, P. Y., Wu, T. L., Huang, S. P., Chen, Y. Y., Chen, M. F. … Lin, K. P. (2022). Forrest classification for bleeding peptic ulcer: A new look at the old endoscopic classification. Diagnostics, 12(5), 1066. https://doi.org/10.3390/diagnostics12051066
18. Zhang, M., Liu, D., Wang, Q., Geng, X., Hou, Q., Gu, G. … Cui, W. (2021). Gastrointestinal bleeding in patients admitted to cardiology: Risk factors and a new risk score. Hellenic Journal of Cardiology, 62(4), 291–296. https://doi.org/10.1016/j.hjc.2020.07.003