RETROSPECTIVE REVIEW OF HEMOGRAM PARAMETERS AND VITAL FINDINGS IN PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL TRACT BLEEDING

Year 2024, , 45 - 51, 18.03.2024

Aslıhan Çelik , Hamit Hakan Armağan , Kıvanç Karaman , Önder Tomruk , Gökben Beceren , Furkan Çağrı Oğuzlar , Cihangir Çelik

https://doi.org/10.17343/sdutfd.1377814

Abstract

Objective
Bleeding originating from proximal to the ligament of
Treitz is referred to as upper gastrointestinal tract (GI)
bleeding. Upper GI bleeding is an important cause
of morbidity and mortality and should be excluded
in patients presenting with blood in the mouth, black
stools or blood in the stool. Diagnosis of upper GI
bleeding, prediction of prognosis and mortality,
and early intervention are crucial in emergency
departments. In this study, we aimed to determine
the prognostic value of hemogram parameters, vital
values and risk scores in patients hospitalized with
upper GI bleeding from emergency department.
Material and Method
In this study, 259 patients aged 18 years and older
who were admitted to Süleyman Demirel University
Faculty of Medicine Emergency Department between
January 2015 and January 2020 for upper
GI bleeding were retrospectively evaluated. Vital
signs, hemogram parameters such as hemoglobin,
hematocrit, red cell distribution width (RDW), white
blood cell (WBC), platelet, vital values and risk scores
(Glasgow-Blacthford and AIMS65) at admission were
recorded from hospital records. Then survival status
was also investigated. Patients who were pregnant,
had malignancy, hematologic disease, history of
esophageal varices, patients who were discharged
directly from the emergency department, patients
who were referred, patients who left the emergency
department by signing a refusal of treatment or without
permission, and patients whose file data could not be
accessed were not included in the study.
Results
A total of 259 patients (157 females, 102 males,
mean age: 72.7±17 years) with non-variceal upper
GI bleeding were included in the study. Patients who
died had significantly higher age, shock index, pulse
rate, neutrophil/lymphocyte ratio, RDW, Glasgow-
Blatchford and AIMS65 scores (p:0.009; p<0.001;
p:0.004; p:0.013; p:0.001; p<0.001; p<0.001;
respectively) and lower mean arterial pressure
(p:0.006). As a result of the ROC analysis, it was
observed that AIMS65 score above the threshold
of 2 had the highest sensitivity (82.5%) and RDW
above the threshold of 16.5 had the highest specificity
(62.6%) in predicting mortality in patients with upper
GI bleeding.
Conclusion
Evaluation of vital values, shock index, neutrophil/
lymphocyte ratio, RDW, AIMS65 and Glasgow-
Blatchford score in patients with upper GI bleeding
admitted to the emergency department contributes to
the emergency physician to predict prognosis, need
for early treatment and mortality. WBC and platelet
indices are thought to have no effect in predicting
prognosis and mortality.

Keywords

Upper gastrointestinal bleeding, vital signs, hemogram

VARİS DIŞI ÜST GASTROİNTESTİNAL SİSTEM KANAMALI HASTALARDA HEMOGRAM PARAMETRELERİ VE VİTAL BULGULARIN GERİYE DÖNÜK İNCELENMESİ

Abstract

Amaç
Üst gastrointestinal sistem (GİS) kanamaları treitz ligamentinin
proksimalinden kaynaklanan kanamalardır.
Ağızdan kan gelmesi, dışkıda siyahlaşma veya
dışkıda kan görülmesi şikâyeti ile başvuran hastalarda
dışlanması gereken üst GİS kanaması önemli bir
morbidite ve mortalite sebebidir. Acil servislerde üst
GİS kanama tanısı, prognoz ve mortalitenin tahmin
edilmesi ve erken müdahale oldukça önemlidir. Biz bu
çalışmamızda acil servise varis dışı üst GİS kanama
ile başvuran ve yatışı yapılan hastalarda hemogram
değerleri, vital bulgular ve risk skorlamalarının prognostik
değerini sorgulamayı amaçladık.
Gereç ve Yöntem
Çalışmamızda Süleyman Demirel Üniversitesi Tıp Fakültesi
Acil Servisi’ne üst GİS kanama sebebiyle Ocak
2015 – Ocak 2020 tarihleri arasında başvuran 18 yaş
ve üzeri hastalar dahil edilmiştir. Vital bulgular, hemoglobin,
hemotokrit, eritrosit dağılım genişliği (RDW),
beyaz kan hücresi (WBC), trombosit gibi hemogram
parametreleri, vital değerler ve başvuru sırasındaki
risk skorları (Glasgow-Blacthford ve AIMS65) hastane
kayıtlarından kaydedilmiştir. Sonrasında hastaların
sağkalım durumu incelenmiştir. Çalışmaya gebe olan,
malignitesi olan, hematolojik hastalığı olan, özefagus
varisi öyküsü olan, acil servisten direkt taburcu olan,
sevk edilen, tedavi reddi imzalayarak veya izinsiz olarak
acil servisi terk eden hastalar ile dosya verilerine
ulaşılamayan hastalar dahil edilmemiştir.
Bulgular
Çalışmaya varis dışı üst GİS kanaması olan toplam
259 hasta (157 kadın, 102 erkek, ortalama yaş:
72,7±17 yıl) dahil edildi. Sağkalım durumu incelendiğinde
ölen hastaların anlamlı derecede daha yüksek
yaşa, şok indeksine, nabız sayısına, nötrofil/lenfosit
oranına, RDW, Glasgow-Blatchford ve AIMS65 skorlarına sahip oldukları (p:0,009; p<0,001; p:0,004;
p:0,013; p:0,001; p<0,001; p<0,001; sırasıyla),
daha düşük ortalama arter basıncına sahip oldukları
(p:0,006) görüldü. Yapılan ROC analizi sonucunda
üst GİS kanamalı hastalarda mortalite tahmininde
AIMS65 skorunun 2 eşik değerin üzerinde olması en
yüksek sensitiviteye (%82,5) RDW’nin 16,5 eşik değerin
üzerinde olması en yüksek spesifiteye (%62,6)
sahip olduğu gözlendi.
Sonuç
Acil servise başvuran üst GİS kanamalı hastalarda vital
değerler, şok indeksi, nötrofil/lenfosit oranı, RDW,
AIMS65 ve Glasgow-Blatchford skorunun değerlendirilmesi
acil servis hekimine prognoz, erken tedavi
ihtiyacı ve mortaliteyi tahmin etmesinde katkı sağlamaktadır.
WBC ve trombosit indekslerinin prognoz ve
mortaliteyi tahmin etmede bir etkisinin olmadığı düşünülmektedir.

Keywords

Üst gastrointestinal sistem kanaması, vital bulgular, hemogram

References

• 1. Khamaysi I, Gralnek IM. Acute upper gastrointestinal bleeding (UGIB)–initial evaluation and management. Best Practice & Research Clinical Gastroenterology 2013;27(5):633-8.
• 2. Tham J, Stanley A. Clinical utility of pre-endoscopy risk scores in upper gastrointestinal bleeding. Expert Review of Gastroenterology & Hepatology 2019;13(12):1161-7.
• 3. O’malley T, Langhorne P, Elton RA, et al. Platelet size in stroke patients. Stroke 1995;26(6):995-9.
• 4. Berdzuli N, Lomia N, Staff AC, et al. Audit of early and late maternal deaths in georgia: potential for improving substandard obstetric care. International Journal of Women's Health 2021;205-19.
• 5. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet 2000;356(9238):1318-21.
• 6. Hyett BH, Abougergi MS, Charpentier JP, et al. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointestinal Endoscopy 2013;77(4): 551-7.
• 7. Zaltman C, Souza HS, Castro ME, et al. Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records. Arquivos de Gastroenterología 2002;39:74-80.
• 8. Altinbilek E, Öztürk 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: Journal for Intesive Care and Emergency Medicine 2019;15(2):59-64.
• 9. Alyeşil E, Usta H, Kızdanoglu H, et al. Kliniğimize yatırılan üst GIS kanamalı hastaların değerlendirilmesi. İstanbul Tıp Dergisi 2005;4:7-10.
• 10. Robertson M, Majumdar A, Boyapati R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointestinal Endoscopy 2016;83(6):1151-60.
• 11. Bishay K, Tandon P, Fisher S, et al. Clinical factors associated with mortality in cirrhotic patients presenting with upper gastrointestinal bleeding. Journal of the Canadian Association of Gastroenterology 2020;3(3):127-34.
• 12. Fukuda S, Shimodaira Y, Watanabe K, et al. Risks for rebleeding and in-hospital mortality after gastrointestinal bleeding in a tertiary referral center in Japan. Digestion 2020;101(1):31-7.
• 13. Rassameehiran S, Teerakanok J, Suchartlikitwong S, et al. Utility of the shock index for risk stratification in patients with acute upper gastrointestinal bleeding. Southern Medical Journal 2017;110(11):738-43.
• 14. Peng B, Wang YH, Liu YM, et al. Prognostic significance of the neutrophil to lymphocyte ratio in patients with non-small cell lung cancer: a systemic review and meta-analysis. International Journal of Clinical and Experimental Medicine 2015;8(3):3098.
• 15. Chen IC, Hung MS, Chiu TF, et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med 2007;25:774-9.
• 16. Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol 2019;42-43:101613.
• 17. Abusaada K, Asad-Ur-Rahman F, Pec V, et al. Blatchford score is superior to AIMS65 score in predicting the need for clinical interventions in elderly patients with nonvariceal upper gastrointestinal bleed. Advances in Medicine 2016; 6850754.
• 18. Tantai XX, Liu N, Yang LB, et al. Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding. World Journal of Gastroenterology 2019;25(45):6668.