Varis dışı üst gastrointestinal kanamalarında tekrar kanama, morbidite ve mortalite'yi predikte eden göstergeler
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Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Üst GİS kanaması hayatı tehdit eden gastroenterolojik acillerden biridir. Bu araştırmada kanama nedenleri, klinik ve endoskopik skorlama sistemlerinin duyarlılık ve özgüllüğünü saptayarak morbidite ve mortaliteyle ilişki faktörleri incelemeyi amaçladık. Çalışmamıza Nisan 2019 – Nisan 2021 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Acil Servis Anabilim Dalı polikliniğine başvuran, varis dışı üst gastrointestinal kanama tanısı konulan ve Gastroenteroloji Bilim Dalı kliniğine yatırılan 262 hasta dahil edildi. Hastaların %71,8’inin erkek cinsiyet, en sık başvuru şikayetinin siyah dışkılama, en sık fizik muayene bulgusunun melena olduğunu saptadık. Hemodinamik olarak hastaların yarısından çoğunun kararlı olduğunu gördük. Hastaların %75,2’sinin en az bir adet komorbid hastalığı mevcut olup; en sık komorbiditenin sistemik arteriyel hipertansiyon olduğunu belirledik. Antitrombotik ilaç kullanımının %51,1, NSAİİ kullanımının %24,8 oranında olduğu görüldü. Peptik ülser hastalığı en sık kanama nedeni olarak saptandı. Hastanede yatış süresi ortalama 6,96 ± 5,1 (1-49) gün saptandı; hastaların %11,1’i yeniden kanadı. Hastaların %22,1’inin endoskopik tedavi, %82’sinin kan transfüzyonu, %5,3’ünün YBÜ, %2,7’sinin cerrahi müdahale gereksinimi oldu. İlk 30 gün içinde hastaların %9,2’si öldü. Rockall skoru; 30 günlük mortalite, YBÜ gereksinimi, yeniden kanama ve transfüzyon gereksinimini öngörmede başarılı bulundu. GB skoru; YBÜ gereksinimi ve transfüzyon gereksinimini öngörmede başarılı bulundu. Otuz günlük sağkalımda cerrahi ihtiyacı olan grup ile olmayan grup arasında istatistiksel olarak anlamlı fark saptandı.
Upper gastrointestinal bleeding is one of the life-threatening gastroenterological emergencies. In this study, we aimed to determine the causes of bleeding, the sensitivity and specificity of clinical and endoscopic scoring systems and to examine the factors associated with morbidity and mortality. Our study included 262 patients who applied to the Trakya University Faculty of Medicine Emergency Department between April 2019 and April 2021, were evaluated by us and diagnosed with non-variceal upper gastrointestinal bleeding and were hospitalized in the Gastroenterology Department. We found that 71.8% of the patients were male, the most common complaint and finding was black stool and the most common physical examination finding was melena. Over half of the patients were hemodynamically stable. 75.2% of the patients have at least one comorbid disease and we determined that the most common comorbidity was hypertension. Antithrombotic drug use was 51.1%, non steroidal anti- inflammatory drug use was 24.8%. The most common cause of bleeding was peptic ulcer disease. The mean length hospital stay was 6.96 ± 5.1 (1-49) days and 11.1% of the patients bled again. Of a total of 262 patients, 22.1% required endoscopic treatment, 82% required blood transfusion, 5.3% required intensive care unit and 2.7% required surgical intervention. Within 30 days of hospitalization 9.2% of patients died. According to ROC curve analysis Rockall score showed good performance in predicting 30-day mortality, intensive care unit requirement, rebleeding and blood transfusion requirement. GB score also showed good performance in predicting intensive care unit requirement and blood transfusion requirement. In 30-day survival, a statistically significant difference was found between the group that needed surgery and the group that did not.
Upper gastrointestinal bleeding is one of the life-threatening gastroenterological emergencies. In this study, we aimed to determine the causes of bleeding, the sensitivity and specificity of clinical and endoscopic scoring systems and to examine the factors associated with morbidity and mortality. Our study included 262 patients who applied to the Trakya University Faculty of Medicine Emergency Department between April 2019 and April 2021, were evaluated by us and diagnosed with non-variceal upper gastrointestinal bleeding and were hospitalized in the Gastroenterology Department. We found that 71.8% of the patients were male, the most common complaint and finding was black stool and the most common physical examination finding was melena. Over half of the patients were hemodynamically stable. 75.2% of the patients have at least one comorbid disease and we determined that the most common comorbidity was hypertension. Antithrombotic drug use was 51.1%, non steroidal anti- inflammatory drug use was 24.8%. The most common cause of bleeding was peptic ulcer disease. The mean length hospital stay was 6.96 ± 5.1 (1-49) days and 11.1% of the patients bled again. Of a total of 262 patients, 22.1% required endoscopic treatment, 82% required blood transfusion, 5.3% required intensive care unit and 2.7% required surgical intervention. Within 30 days of hospitalization 9.2% of patients died. According to ROC curve analysis Rockall score showed good performance in predicting 30-day mortality, intensive care unit requirement, rebleeding and blood transfusion requirement. GB score also showed good performance in predicting intensive care unit requirement and blood transfusion requirement. In 30-day survival, a statistically significant difference was found between the group that needed surgery and the group that did not.
Açıklama
Anahtar Kelimeler
Üst gastrointestinal sistem kanaması, Rockall skoru, Glasgow- Blatchford skoru, Upper gastrointestinal bleeding, Rockall score, Glasgow-Blatchford score
