Are the blood urea nitrogen/creatinine ratio and the mean platelet volume able to act as predictors of mortality and morbidity in patients with upper gastrointestinal bleeding?

Year 2021, Volume: 3 Issue: 4, 274 - 278, 24.09.2021

Burçak Kantekin , Mücahit Avcil , Mücahit Kapçı , Adnan Bilge , Sema Avcı

https://doi.org/10.38053/acmj.939406

Cited By: 1

Abstract

Background: Upper gastrointestinal (GI) bleeding originates above the Treitz ligament and blood urea nitrogen (BUN)/Creatinine (Cr) ratio ≥30 was shown to indicate the presence of upper GI bleeding and it might be an independent risk factor for mortality. The mean platelet volume (MPV) was reported as an indicator of platelet function and activation and was shown to be useful in the diagnosis and follow-up of vascular-origin disorders. In the present study, we aimed to investigate whether BUN/Cr ratio and MPV were predictors of mortality and morbidity in patients with upper GI bleeding.
Material and Method: This retrospective study enrolled a total of 141 patients admitted to the Emergency Department with symptoms of upper GI bleeding and had undergone endoscopy between January 2013-January 2015. Demographics, hemoglobin, hematocrit, MPV, BUN/Cr, the hospitalization unit, the duration of stay, outcome, and the endoscopy reports of the patients were recorded. Statistical analysis was performed using SPSS 17.0.
Results:  It was found that the MPV level did not predict mortality and morbidity in our patients with upper GI bleeding. The likelihood of active bleeding was higher in patients with a BUN/Cr ratio of above 30 when compared to those with a ratio of below 30.
Conclusion: In patients presenting to the emergency department with symptoms of GI bleeding but without signs of renal failure, calculation of admission BUN/Cr ratio may be beneficial for making treatment and follow-up plans.

Keywords

upper gastrointestinal bleeding, blood urea nitrogen/creatinine ratio, mean platelet volume, morbidity, mortality

References

• Feldman M, Friedman LS, Sleisenger MH. Gastrointestinal bleeding. Fordtran’s Gastrointestinal and Liver Disease; 2002. page: 211-3.
• Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90: 206-10.
• Tırnaksız B. Gastrointestinal kanamanın cerrahi yönetimi. Yoğun Bakım Derg 2005; 5: 174-81.
• Osman D, Djibre M, Da Silva D, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care 2012; 2: 46.
• Colle I, Wilmer A, Le Moine O, et al. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg 2011; 74: 45-66.
• Uzunismail H. Akut üst gastrointestinal kanama. İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Acil Hekimlik Sempozyumu Oct, 16-17th, 1997; İstanbul. page: 233-45.
• Wu KH, Shih HA, Hung MS, Hsiao CT, Chen YC. The association between blood urea nitrogen to creatinine ratio and mortality in patients with upper gastrointestinal bleeding. Arab J Gastroenterol 2018; 19: 143-7.
• Akpolat T, Utaş C. Günlük nefroloji ve böbrek yetmezliğinde ilaç kullanımı. 2006.
• O’Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patients. Stroke 1995; 26: 995-9.
• Wang CH, Chen YW, Young YR, Yang CJ, Chen IC. A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. Am J Emerg Med 2013; 31: 775-8.
• Krupp MA, Chatton MJ. Current Medical Diagnosis and Treatment. 1984.
• Okutur SK, Alkım C, Bes C, Gürbüz D, Kınık Ö. Akut üst gastrointestinal kanamaları. Akademik Gastroenteroloji Derg 2007; 6: 30-6.
• Sezgin O, Altıntaş E, Tombak A. Effect of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turk J Gastroenterol 18: 172-6.
• Uyanıkoğlu A, Danalıoğlu A, Davutoğlu C, Alimoğlu O, Baş G. Akut üst gastrointestinal sistem kanaması: endoskopi sonuçlarının retrospektif değerlendirilmesi. İstanbul Üniversitesi Tıp Fakültesi Derg 2008; 71: 120-3.
• Yenigün EC, Pirpir A, Aytan P, Ulusal G, Yıldırım İS. Üst gastrointestinal sistem kanamalı hastaların özelliklerinin değerlendirilmesi. Akademik Gastroenteroloji Derg 2006; 5: 116-22.
• Di Fiore F, Lecleire S, Merle V, et al. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol 2005; 17: 641-7.
• Chassaignon C, Letoumelin P, Pateron D, Group HD. Upper gastrointestinal haemorrhage in Emergency Departments in France: causes and management. Eur J Emerg Med 2003; 10: 290-5.
• Göksu E, Erken Ö, Erçetin Y. Akdeniz Üniversitesi Hastanesi Acil Servisine üst gastrointestinal sistem kanaması ile başvuran hastalarda mortaliteyi belirleyen faktörler ve demografik özellikleri. Türkiye Acil Tıp Derg 2004; 4: 121-6.
• Katlar T. Üst gastrointestinal sistem kanamalı hastalarda steroid olmayan antiinflamatuar ilaç kullanımı ve bu hastalarda hemostaz parametrelerine etkilerinin incelenmesi. 2007.
• Altun Y, Demircan F, Mengeloğlu FZ, Namuslu M. Yoğun bakım hastalarında ortalama trombosit hacminin mortalite ile ilişkisi. J Clin Exp Invest 2011; 2: 408-11.
• Yavuzcan A, Çağlar M, Erdem H, et al. Anormal uterin kanamalı hastalarda endometrium kanseri ve benign endometrial patoloji tanısı alanların hematolojik parametrelerinin karşılaştırılması. Van Tıp Derg 2014; 21: 148-53.
• Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med 2006; 24: 280-5.