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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability: A systematic review and meta-analysis
Mahmoud Obeidat, Brigitta Teutsch, Anett Rancz, Edina Tari, Katalin Márta, Dániel Sándor Veres, Nóra Hosszúfalusi, Emese Mihály, Péter Hegyi, Bálint Erőss
Mahmoud Obeidat, Brigitta Teutsch, Anett Rancz, Edina Tari, Katalin Márta, Dániel Sándor Veres, Nóra Hosszúfalusi, Emese Mihály, Péter Hegyi, Bálint Erőss, Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
Mahmoud Obeidat, Brigitta Teutsch, Péter Hegyi, Bálint Erőss, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary
Anett Rancz, Nóra Hosszúfalusi, Emese Mihály, Department of Internal Medicine and Hematology, Semmelweis University, Faculty of Medicine, Budapest 1085, Hungary
Edina Tari, Katalin Márta, Péter Hegyi, Bálint Erőss, Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
Dániel Sándor Veres, Department of Biophysics and Radiation Biology, Semmelweis University, Budapest 1085, Hungary
Author contributions: Obeidat M contributed to conceptualization, investigation, project administration, visualization, validation, writing – original draft; Teutsch B contributed to conceptualization, methodology, project administration, validation, writing – review & editing; Rancz A contributed to conceptualization, investigation, writing – review & editing; Tari E: conceptualization, investigation, writing – review & editing; Márta K contributed to conceptualization, writing – review & editing; Veres DS contributed to conceptualization, formal analysis, software, writing – review & editing; Hosszúfalusi N contributed to conceptualization, writing – review & editing; Mihály E contributed to conceptualization, writing – review & editing; Hegyi P contributed to conceptualization, writing – review & editing; Erőss B contributed to conceptualization, supervision, validation, writing – review & editing; All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.
Supported by The Ministry of Innovation and Technology of Hungary from the National Research, Development, and Innovation Fund (ITM-NRDIF), No. TKP2021-EGA-23.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: All authors have read the PRISMA 2020 checklist, and the manuscript was prepared and revised according to the PRISMA 2020 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bálint Erőss, MD, PhD, Assistant Professor, Doctor, Centre for Translational Medicine, Semmelweis University, Üllői street 26, Budapest 1085, Hungary. dr.eross.balint@gmail.com
Received: February 10, 2023
Peer-review started: February 10, 2023
First decision: May 16, 2023
Revised: May 30, 2023
Accepted: June 14, 2023
Article in press: June 14, 2023
Published online: July 28, 2023
ARTICLE HIGHLIGHTS
Research background
Hemodynamic instability (HI) and shock are associated with unfavorable outcomes in gastrointestinal bleeding (GIB). Understanding the proportion of these outcomes is essential for several reasons. Firstly, it provides valuable insight into the severity and potential risks associated with the condition. Knowing the proportion of patients who develop shock or HI helps healthcare providers anticipate the need for immediate interventions and allocate appropriate resources accordingly.
Research motivation
At the time of our systematic search, there was no data in the current literature describing these proportions in GIB based on the bleeding source. Additionally, monitoring changes in these patients over time can serve as an indicator of the effectiveness of medical interventions and guide future treatment strategies to improve patient outcomes.
Research objectives
Our aim is to quantify the pooled event rates of HI and shock in GIB. This will help in risk stratification and determining the overall severity of the condition. By understanding how frequently these outcomes occur, healthcare providers can identify high-risk patients who require immediate and intensive management.
Research methods
We conducted a systematic review with meta-analysis to determine the proportions of HI and shock in different GIB sources. The R programming language, using the meta package, was employed to perform statistical analysis on the data. Forest plots were utilized to summarize the study findings and present the results. Pooled event rates with 95%CIs, were computed to provide a measure of the overall outcomes.
Research results
The overall proportion of HI and shock was found to be 25% across all sources of GIB, 22% in non-variceal bleeding, 25% in variceal bleeding, and 12% in colonic diverticular bleeding. However, our findings also revealed a high degree of heterogeneity, highlighting the significance of our study. This heterogeneity suggests a lack of consensus in the guidelines in this field, as evidenced by the varied definitions of our included outcomes.
Research conclusions
Our study provides compelling evidence that HI and shock are frequently observed complications and presentations in GIB. One in four patients with GIB develops shock or HI on admission or during the hospital stay.
Research perspectives
Given our findings, we recommend the establishment of a standardized definition for HI and shock in GIB. Additionally, implementing a protocol for proactive screening and continuous monitoring of affected patients should be considered as part of routine management. Emphasizing a thorough pre-endoscopic assessment and strict adherence to risk stratification scores is crucial. Furthermore, rigorous care and attentive monitoring should be emphasized, particularly for high-risk patients.
