Üst GIS Kanama Ön Tanısı ile Acil Servise Başvuran Vital Bulguları Stabil Olan Hastalarda Mortalite için Risk Belirteçleri

Abstract

Amaç: Acil servise üst GİS kanama ön tanısı ile başvuran hemodinamik olarak stabil hastalarda hemoglobin düzeylerindeki değişimin araştırılması amaçlandı. Gereç ve Yöntemler: Bu çalışma, 1 Ocak 2017-1 Mart 2020 tarihleri arasında Ankara Eğitim ve Araştırma Hastanesi acil servise başvuran hastalarda retrospektif olarak yapıldı. Çalışmaya üst GİS kanama ön tanısı ile acil servise başvuran ve endoskopi yapılan 18 yaş üstü erişkinler dahil edildi. Hastaların demografik verileri, laboratuvar parametreleri, Glasgow-Blatchford ve Rockall skorları, endoskopi sonuçları ve 28 günlük mortalite verileri kaydedildi. Bulgular: Çalışmanın örneklemini yaş ortalaması 62,0 ± 20,9 olan 120 hasta oluşturdu. Hastaların hemoglobin düzeylerinin başvuru sırasında ve 3-6 saat içinde yapılan iki ölçüm arasındaki değişim miktarı veya yüzdesi açısından anlamlı fark saptanmadı. ((0.6(-5,6%), 0.4(-5,3%), p>0,05)) En sık endoskopik bulgu 64 (%53,3) hastada saptanan peptik ülserdi. Çoklu değişkenli regresyon analizi, yaşın (Odds Oranı (OR) = 1,13, güven aralığı (CI) %95: 1,03-1,31, p = 0,0031) ve hipertansiyonun (OR = 1,45, CI %95: 1,80-138,88, p = 0.021) 28 günlük mortalite için bağımsız risk faktörleri olduğu saptandı. Sonuç: Hemodinamik olarak stabil olan ve üst GİS kanama ön tanısı olan hastaların hemoglobin düzeylerindeki değişimin miktarı veya yüzdesi açısından başvuru sırasında ve 3-6 saat içinde yapılan iki ölçüm arasında anlamlı fark saptanmadı. Bu hasta grubunda 28 günlük mortaliteyi öngören risk faktörleri olarak ileri yaş ve hipertansiyon belirlendi.

Keywords

• Üst gastrointestinal kanama
• mortalite
• risk belirteçleri
• acil tıp

Risk Markers for Mortality in Hemodynamically Stable Patients Admitted to the Emergency Department with a Prediagnosis of Upper Gastrointestinal Bleeding

Abstract

Aim: The aim of this study is to investigate the changes in hemoglobin levels in hemodynamically stable patients admitted to the emergency department with a prediagnosis of upper GI bleeding. Material and Methods: This study consisted of patients aged over 18 years who applied to the emergency department of Ankara Training and Research Hospital and underwent endoscopy with a prediagnosis of upper GI bleeding between January 1st, 2017, and March 1st, 2020. The patients’ demographic data, laboratory parameters, Glasgow-Blatchford and Rockall scores, endoscopy results, and 28-day mortality data were recorded. Results: The study sample consisted of 120 patients with a mean age of 62.0 ± 20.9 years. No significant difference was detected in the amount or percentage of change in patients' hemoglobin levels between the two measurements performed at admission and within 3-6 hours. ((0.6(-5,6%), 0.4(-5,3%), p>0.05)) The most common endoscopic finding was a peptic ulcer, which was detected in 64 (53.3%) patients. The multivariate regression analysis revealed that age ((Odds Ratio (OR) = 1.13, confidence interval (CI) 95%: 1.03–1.31, p = 0.0031)) and hypertension (OR = 11.45, CI 95%: 1.80–138.88, p = 0.021) were independent risk factors for 28-day mortality. Conclusion: No significant difference was detected in the amount or percentage of change in hemoglobin levels of hemodynamically stable patients with a prediagnosis of upper GI bleeding between the two measurements performed at admission and within 3-6 hours. Older age and hypertension were determined as the risk factors that predicted 28-day mortality in this patient group.

Keywords

• upper gastrointestinal bleeding
• mortality
• risk factor
• emergency medicine

References

1. Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med. 2018; 36(1): 27-32.
2. Bae SJ, Kim K, Yun SJ, Lee SH. Predictive performance of blood urea nitrogen to serum albumin ratio in elderly patients with gastrointestinal bleeding. Am J Emerg Med. 2021; 41: 152-7.
3. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021; 116(5): 899-917.
4. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47(10): a1-46.
5. Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021; 53(3): 300-332.
6. Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018; 67(10): 1757-68.
7. Mokhtare M, Bozorgi V, Agah S, Nikkhah M, Faghihi A, Boghratian A, et al. Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding. Clinical and Experimental Gastroenterology. 2016; 9(9): 337-43.
8. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann Intern Med. 2019; 171(11): 805-22.

9. Kaya E, Karaca MA, Aldemir D, Ozmen MM. Predictors of poor outcome in gastrointestinal bleeding in emergency department. World J Gastroenterol. 2016; 22(16): 4219-25.
10. Shingina A, Barkun AN, Razzaghi A, Martel M, Bardou M, Gralnek I. RUGBE Investigators. Systematic review: the presenting international normalised ratio (INR) as a predictor of outcome in patients with upper nonvariceal gastrointestinal bleeding. Aliment Pharmacol Ther. 2011; 33(9): 1010-8.
11. Nikolsky E, Stone GW, Kirtane AJ, Dangas GD, Lansky AJ, McLaurin B, et al. Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol. 2009; 54(14): 1293-302.
12. Hajiagha Mohammadi AA, Reza Azizi M. Prognostic factors in patients with active non-variceal upper gastrointestinal bleeding. Arab J Gastroenterol 2019; 20(1): 23-7.
13. Bedel C, Korkut M, Avcı A, Uzun A. Immature granulocyte count and percentage as new predictors of mortality in patients with upper gastrointestinal bleeding. Indian J Crit Care Med. 2020; 24(9): 794-8.
14. Narcı H, Berkeşoğlu M, Üçbilek E, Ayrık C. The usefulness of the percentage of immature granulocytes in predicting in-hospital mortality in patients with upper gastrointestinal bleeding. Am J Emerg Med. 2021; 46: 646-50.
15. Nalbant, S, Karan, MA. İç hastalıkları uzmanının anemiye yaklaşımı rehberi. İç hastalıkları derg. 2010; 17: 7-15.
16. Isik B, Yilmaz MS, Yel C, Kavalci C, Solakoglu GA, Ozdemir M, et al. Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage. J Pak Med Assoc. 2016; 66: 151-4.
17. Han YJ, Cha JM, Park JH, Jeon JW, Shin HP, Joo KR, et al. Successful endoscopic hemostasis is a protective factor for Rebleeding and mortality in patients with nonvariceal upper gastrointestinal bleeding. Dig Dis Sci. 2016; 61: 2011-8.
18. Thomopoulos KC, Vagenas KA, Vagianos CE, Margaritis VG, Blikas AP, Katsakoulis EC et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during last 15 years. Eur J Gastroenterol Hepatol. 2004; 16: 177-82.
19. Lenti MV, Pasina L, Cococcia S, Cortesi L, Miceli E, Caccia Dominioni C, et al. REPOSI Investigators. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med. 2019; 61: 54-61.
20. Elsebaey MA, Elashry H, Elbedewy TA, Elhadidy AA, Esheba NE, Ezat S, et al. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding. Medicine (Baltimore). 2018: 97(16): e0403.
21. Hwang S, Jeon SW, Kwon JG, Lee DW, Ha CY, Daegu-Gyengbuk, et al. Gastrointestinal Study Group (DGSG). The novel scoring system for 30-day mortality in patients with non-variceal upper gastrointestinal bleeding. Dig Dis Sci. 2016; 61(7): 2002-10.
22. Lee YJ, Min BR, Kim ES, Park KS, Cho KB, Jang BK, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med. 2016; 31(1): 54-64.