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

Year 2023, Volume: 13 Issue: 3, 378 - 384, 21.09.2023

Emel Altıntaş , Serdal Ateş , Murat Ongar , Ali Kaan Ataman , İlyas Tenlik , Levent Filik

https://doi.org/10.33631/sabd.1294141

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

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

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