Ulus Travma Acil Cerrahi Derg. 2022; 28(2): 147-154 | DOI: 10.14744/tjtes.2021.00670

Üst gastrointestinal kanamasý olan hastalarýn özellikleri ve yeniden kanama riskini etkileyen faktörler.

Emin Uysal¹, Yahya Ayhan Acar^2
1Saðlýk Bilimleri Üniversitesi Baðcýlar Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ýstanbul
²Saðlýk Bilimleri Üniversitesi Gülhane Týp Fakültesi, Acil Týp Anabilim Dalý, Ankara

AMAÇ: Üst gastrointestinal kanamalarýnda (ÜGÝK) tekrar kanama riski mortal seyredebilen ve önemli bir komplikasyondur. Bu çalýþmada tekrar kanama riskini öngörebilecek faktörlerin saptanmasý amaçlandý.
GEREÇ VE YÖNTEM: ÜGÝK ile eriþkin yoðun bakýma yatan hastalar geriye dönük olarak tarandý. Yaþ ve cinsiyetin yanýnda hastalarýn baþvuru yakýnmasý, vital bulgularý, komorbiditeleri, laboratuvar bulgularý, kullandýðý ilaçlar, endoskopi durumu ve tekrar kanama durumlarý kaydedildi. Bu bulgular ýþýðýnda hastalarýn Glasgow-Blatchford ve AIMS65 skorlarý hesaplandý. Ýstatistiksel inceleme için Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL) paket program kullanýldý.
BULGULAR: Toplam 241 hasta çalýþmaya alýndý. Hastalarýn ortalama yaþý 57.58±19.3 yýldý ve olgularýn 176’sý (%73.0) erkekti. Hastalarýn 77’sinde (%32.0) tekrar kanama olduðu ve 117’sinin (%48.5) H. pylori pozitif olduðu saptandý. Toplam 103 (%42.7) hastaya skleroterapi, beþ (%2.1) hastaya elektrokoagülasyon, dört (%1.7) hastaya hemoklips uygulandýðý ve endoskopi yapýlan ve yapýlmayan hastalar arasýnda tekrar kanama açýsýndan anlamlý fark olduðu saptandý (p<0.001). Hematokrit ve üre deðerleri ile Glasgow-Blatchford ve AIMS65 skorlarýnýn tekrar kanama olan ve olmayan gruplar arasýnda istatistiksel olarak fark olduðu saptandý (sýrasýyla, p=<0.00, <0.001, <0.001, 0.008). Glasgow Blatchford ve AIMS65 skorlama sistemlerinin tekrar kanama riskini öngörmedeki performansýnýn deðerlendirilmesi için yapýlan ROC analizinde AUC deðerleri sýrasýyla 0.700 (p<0.001, %95 Güven Aralýðý-GA: 0.626–0.775) ve 0.557 (p=0.194, %95 GA: 0.469–0.645) olarak hesaplandý. Hastalarýn 5’inde (%2.1) mortalite görüldüðü saptandý.
TARTIÞMA: Üst GÝS kanamasýnda tekrar kanama riski için laboratuvar deðerlerinden hematokrit ve üre deðerleri faydalý olabilirken, skorlama
sistemlerinden Glasgow-Blatchford skorlama sisteminin AIMS65’e göre daha iyi performans gösterdiði saptanmýþtýr. Klinisyenler için daha spesifik öngörücü belirteçlerin faydalý olabileceði deðerlendirilmiþtir.

Anahtar Kelimeler: AIMS65 skoru, Glasgow-Blatchford skoru; hematokrit; tekrar kanama, üre; üst gastrointestinal kanama.

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Features of patients with upper gastrointestinal bleeding and factors affecting the re-bleeding risk

Emin Uysal¹, Yahya Ayhan Acar^2
1Department of Emergency Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
²Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey

BACKGROUND: The risk of re-bleeding in upper gastrointestinal bleeding (UGIB) is a major complication that can be mortal. In this study, we aimed to determine the factors that can predict the risk of re-bleeding in UGIB patients.
METHODS: We retrospectively screened UGIB patients admitted in adult intensive care. Along with age and gender, complaints of admission, vital signs, comorbidities, laboratory findings, medications, endoscopy status, and re-bleeding status were recorded. According to these findings, Glasgow-Blatchford and AIMS65 scores of the patients were calculated. All statistical tests were performed with the Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL).
RESULTS: A total of 241 patients were included in the study. Mean age of patients was 57.58±19.31, years and 176 (73.0%) of them were male. A total of 117 (48.5%) patients were Helicobacter pylori positive and re-bleeding occurred in 77 (32.0%) patients. Sclerotherapy was applied in 103 (42.7%) patients, while 5 (2.1%) underwent electrocoagulation, and 4 (1.7%) underwent hemoclips. There was a significant difference between patients with and without endoscopic intervention for re-bleeding (p<0.001). Hematocrit, urea values, Glasgow-Blatchford, and AIMS65 scores were statistically significant different between the groups with and without re-bleeding (p=<0.001, <0.001, <0.001, and 0.008, respectively). In the ROC analysis of Glasgow-Blatchford and AIMS65 scoring systems area, under the curve values were 0.700 (p=<0.001, 95% CI: 0.626–0.775), and 0.557 (p=0.194, CI 95%: 0.469–0.645), respectively. Mortality rate was 2.1% (n=5) among study population.
CONCLUSION: Hematocrit and urea values seem beneficial among studied laboratory values, however, Glasgow-Blatchford scoring system performed better than AIMS65 in the prediction of re-bleeding risk in UGIB. The authors concluded that more specific predictive markers may be useful for clinicians.

Keywords: AIMS65 score, Glasgow-Blatchford score; hematocrit; re-bleeding; upper gastrointestinal bleeding; urea.

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