Prognostic Usage of Lactate Levels in Patients with Upper Gastrointestinal Bleeding

Öz

Aim: Glasgow Blatchford Score (GBS) and Rockall score is the most widely used scoring system for risk classification of patients with upper gastrointestinal bleeding. Lactate levels is not used by any of those scoring systems. Lactate levels is a determinant factor in a variety of conditions including shock, trauma and sepsis. The aim of our study was to investigate prognostic value of serum lactate levels in patients who have GI bleeding. Material and Method: Patients with the age 18 and older who were diagnosed upper gastrointestinal system bleeding, between May 1, 2015 and May 31, 2016, were enrolled in the study. The age, sex, hemoglobin and lactate values in emergency admission, the need for blood transfusion, chronic disease and GBS values were recorded in the data sheet. We investigated the association between blood transfusion and intensive care with lactate level. SPSS 22.0 (IBM Corporation, Armonk, New York, United States) program was used to analyze the variables. Results: 78 patients were included in the study. 27 patients (34.6%) were female and 51 (65.4) were male. The mean age was 67.6±17.75 (min: 22, max: 100). The median lactate levels were 2.2 mmol/L for patients who need blood transfusion and 1.9 mmol/L for patients who who didn’t need. . This difference was not statistically significant (p=0.450). The median lactate levels were 3.9 mmol/L for patients who hospitalized in intensive care and 1.9 mmol/L for patients who did not need intensive care. This difference was statistically significant (p=0.038). Conclusion: In our study, significant relationship between intensive care hospitalization and lactate levels was found; but between the need for blood transfusion and lactate levels we didn’t find a significant relationship

Anahtar Kelimeler

• lactate; gastrointestinal; bleeding; blood transfusion; intensive care

Laktat Seviyesinin Üst Gastrointestinal Sistem Kanamalı Hastalarda Prognostik Amaçlı Kullanımı

Öz

Amaç: Üst GİS kanamalı hastaların risk sınıflandırılmasında en çok Glasgow Blatchford Skoru (GBS) ve Rockall Skoru kullanılmaktadır.Bu skorlama sistemlerinin hiçbirinde serum laktat seviyesi kullanılmamaktadır. Laktat seviyesi travma ve sepsis dahil çeşitli şok durumlarında mortalite beliryecisidir. Çalışmamızın amacı üst GİS kanamalı hastalarda serum laktat seviyesinin prognostik amaçlı kullanımını araştırmaktır. Materyal ve Metot: 1 Mayıs 2015 ve 31 Mayıs 2016 tarihleri arasında, üst gastrointestinal sistem (GİS) kanaması tanısı konmuş 18 yaş ve üstü hastalar çalışmaya alındı. Hastaların yaş, cinsiyet, acil servis kabulündeki hemoglobin ve laktat değeri, kan transfüzyon ihtiyacı, kronik hastalıkları ve GBS değerleri veri formuna kaydedildi. Kan transfüzyon ve yoğun bakım ihtiyacı ile laktat düzeyi arasındaki ilişki araştırıldı. Değişkenlerin analizinde SPSS 22.0 (IBM Corparation, Armonk, New York, United States) programı kullanıldı. Bulgular: Çalışmaya 78 hasta dahil edildi. Hastaların 27’si (%34,6) kadın, 51’i (65,4) erkekti. Yaş ortalaması 67,6±17,75 (min: 22, max: 100) olarak saptandı. Kan transfüzyonu yapılan hastaların median laktat değeri 2,2 mmol/L, kan transfüzyonu yapılmayan hastaların median laktat değeri 1,9 mmol/L olarak bulundu. Bu fark istatiksel olarak anlamlı bulunmadı (p=0,450). Servise yatan hastaların median laktat değeri 1,9 mmol/L, yoğun bakıma yatan hastaların median laktat değeri 3,9 mmol/L bulundu. Bu iki grup arasındaki fark istatiksel olarak anlamlı bulundu (p=0,038). Sonuç: Üst GİS kanamalı hastalarda yoğun bakım ve servis yatışları ile laktat düzeyi arasında anlamlı ilişki saptanmışken; kan transfüzyonu alan ve almayan hastalar arasında laktat düzeyi açısından anlamlı bir ilişki saptanmamıştır 

Anahtar Kelimeler

• laktat; gastrointestinal; kanama; kan transfüzyonu; yoğun bakım

Kaynakça

1. 1. Shah A, Chisolm-Straker M, Alexander A, Ratu M, Dikdan S, Manini AFD. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage, Am J Emerg Med 2014;32:752–755. 2. Ali H, Lang E, Barkan A. Emergency department risk stratification in upper gastrointestinal bleeding. CJEM 2012;14(1):45–49. 3. Chen C, Hung M, Chiu T, Chen J, Hsiao C. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. American Journal of Emergency Medicine 2007;25:774–779. 4. Srirajaskanthan R, Conn R, Bulwer C, et al. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal hemorrhage. Int J Clin Pract 2010;64:868–874. 5. Stanley AJ, Ashley D, Dalton HR, et al. Outpatient management of patients with low-risk upper-gastrointestinal hemorrhage: multicentre validation of prospective evaluation. Lancet 2009;373:42–7. 6. Neville AL, Nemtsev D, Manasrah R, Bricker SD, Putnam BA. Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg 2011;77:1337–41. 7. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septik shock. Am J Surg 1996;171(2):221–6. 8. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005;45(5):524–8. 9. Nguyen HB, Loomba M, Yang JJ, Jacobesen G, Shah K, Otero RM, et al. Early lactate clearance is associated with biomakers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm (Lond)2010;7–6. 10. Bakker J, Jansen TC. Don’t take vitals, take a lactate. Intensive Care Med 2007;33(11)1863–5. 11. El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in criticaly ill patients with acute upper gastrointestinal bleeding. J Emerg Med 2015;49(3):318–325. 12. Köksal O, Ozeren G, Ozdemir F, Armağan E, Aydın S, Ayyıldız T. Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department Turk J Gastroenterol 2012;23(5):448–455. 13. Kim, J. Management and Prevention of Upper GI Bleeding. Gastroenterolog y and Nutrition Series PSAP-VII, 2012:7–26.