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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
BACKGROUND
Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding. However, there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding.
AIM
To determine the pooled event rates in the available literature and specify them based on the bleeding source.
METHODS
The protocol was registered on PROSPERO in advance (CRD42021283258). A systematic search was performed in three databases (PubMed, EMBASE, and CENTRAL) on 14th October 2021. Pooled proportions with 95%CI were calculated with a random-effects model. A subgroup analysis was carried out based on the time of assessment (on admission or during hospital stay). Heterogeneity was assessed by Higgins and Thompson’s I2 statistics. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment. The Reference Citation Analysis (https://www.referencecitationanalysis.com/) tool was applied to obtain the latest highlight articles.
RESULTS
We identified 11589 records, of which 220 studies were eligible for data extraction. The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25 (95%CI: 0.17-0.36, I2 = 100%). In non-variceal bleeding, the proportion was 0.22 (95%CI: 0.14-0.31, I2 = 100%), whereas it was 0.25 (95%CI: 0.19-0.32, I2 = 100%) in variceal bleeding. The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12 (95%CI: 0.06-0.22, I2 = 90%). The risk of bias was low, and heterogeneity was high in all analyses.
CONCLUSION
One in five, one in four, and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal, variceal, and colonic diverticular bleeding, respectively.
Core Tip: Gastrointestinal bleeding is one of the most common gastrointestinal emergencies with estimated mortality up to 10%. It is associated with significant morbidity, additional burden, and health care costs. It is documented that hemodynamic instability and shock are highly associated with untoward outcomes; they lead to a higher mortality rate, rebleeding risk, prehospital transfusion, and sedation complications. Our study provides clear evidence that hemodynamic instability and shock are common presentations and complications in gastrointestinal bleeding and gives insight into some possible predictor factors.
