Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2016; 22(16): 4219-4225
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4219
Predictors of poor outcome in gastrointestinal bleeding in emergency department
Ender Kaya, Mehmet Ali Karaca, Deniz Aldemir, M Mahir Ozmen
Ender Kaya, Dr. Nafiz Korez State Hospital, Sincan 06932, Ankara, Turkey
Mehmet Ali Karaca, Deniz Aldemir, Emergency Medicine Department, Faculty of Medicine, Hacettepe University, Sihhiye 06100, Ankara, Turkey
M Mahir Ozmen, General Surgery Department, Faculty of Medicine, Hacettepe University, Sihhiye 06100, Ankara, Turkey
Author contributions: Kaya E and Karaca MA contributed equally to planning the study, collecting and analyzing the data, and drafting the manuscript; Aldemir D contributed in collecting the data; Ozmen MM revised the manuscript for important intellectual content.
Conflict-of-interest statement: The authors have no commercial association or sources of support that might pose a conflict interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mehmet Ali Karaca, MD, Emergency Medicine Department, Faculty of Medicine, Hacettepe University, Sihhiye 06100, Ankara, Turkey. mehmetalikaraca@gmail.com
Telephone: +90-532-5918202 Fax: +90-312-3052512
Received: December 3, 2015
Peer-review started: December 4, 2015
First decision: January 28, 2016
Revised: February 10, 2016
Accepted: March 1, 2016
Article in press: March 2, 2016
Published online: April 28, 2016
Abstract

AIM: To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases.

METHODS: The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit (ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints.

RESULTS: The mean age of patients was 61.92-years-old. Among the 600 total patients, 363 (60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer (19.2%) and gastric ulcer (12.8%). One-hundred-and-fifteen (19.2%) patients required endoscopic treatment, 20 (3.3%) required surgical treatment, and 5 (0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 ± 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates (P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay (P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels (P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation (P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale (GCS) were independent predictive factors of mortality.

CONCLUSION: Prognostic factors for gastrointestinal bleeding in emergency room cases are malignancy, hypotension on admission, low GCS, and impaired kidney function.

Keywords: Gastrointestinal bleeding, Poor prognosis, Mortality, Emergency department, Kidney function, Malignancy

Core tip: Early diagnosis and identification of patients at high risk of poor prognosis with gastrointestinal bleeding may increase survival rates. Identification of factors associated with prognosis based upon findings at admission to the emergency department will help to improve management of patients with gastrointestinal bleeding.